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Schurr TG, Dulik MC, Cafaro TA, Suarez MF, Urrets-Zavalia JA, Serra HM. Genetic background and climatic droplet keratopathy incidence in a Mapuche population from Argentina. PLoS One 2013; 8:e74593. [PMID: 24040292 PMCID: PMC3764023 DOI: 10.1371/journal.pone.0074593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/05/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine whether the incidence of and susceptibility to climatic droplet keratopathy (CDK), an acquired, often bilateral degenerative corneal disease, is influenced by the genetic background of the individuals who exhibit the disorder. Methods To determine whether the disease expression was influenced by the genetic ancestry of CDK cases in native Mapuche of the northwest area of Patagonia in Argentina, we examined mitochondrial DNA and Y-chromosome variation in 53 unrelated individuals. Twenty-nine of them were part of the CDK (patient) population, while 24 were part of the control group. The analysis revealed the maternal and paternal lineages that were present in the two study groups. Results This analysis demonstrated that nearly all persons had a Native American mtDNA background, whereas 50% of the CDK group and 37% of the control group had Native American paternal ancestry, respectively. There was no significant difference in the frequencies of mtDNA haplogroups between the CDK patient and control groups. Although the Y-chromosome data revealed differences in specific haplogroup frequencies between these two groups, there was no statistically significant relationship between individual paternal genetic backgrounds and the incidence or stage of disease. Conclusions These results indicate a lack of correlation between genetic ancestry as represented by haploid genetic systems and the incidence of CDK in Mapuche populations. In addition, the mtDNA appears to play less of a role in CDK expression than for other complex diseases linked to bioenergetic processes. However, further analysis of the mtDNA genome sequence and other genes involved in corneal function may reveal the more precise role that mitochondria play in the expression of CDK.
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Zoega GM, Arnarsson A, Sasaki H, Söderberg PG, Jonasson F. The 7-year cumulative incidence of cornea guttata and morphological changes in the corneal endothelium in the Reykjavik Eye Study. Acta Ophthalmol 2013; 91:212-8. [PMID: 22339815 DOI: 10.1111/j.1755-3768.2011.02360.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To examine the corneal endothelium and establish the 7-year cumulative incidence of cornea guttata (CG). METHODS Population-based prospective cohort study with 573 participants (third wave of the Reykjavik Eye Study (RES) in 2008). Four hundred and thirty-seven subjects had either right or left eyes available for analysis after excluding confounding eye conditions. The baseline for eyes at risk for developing CG is the second wave of the RES in 2001. Participants underwent specular microscopy and a standardized eye examination. RESULTS The cumulative 7-year incidence of CG in either eye was estimated as a 95% confidence interval for the expected value for both genders combined (15-23%), for males (8-18%) and for females (19-29%). In right eye only, the 7-year cumulative incidence for both genders combined was estimated to be 6-11%. For genders combined and for males only, the data indicated no correlation between 7-year cumulated incidence and age at baseline. In women, however, the change of 7-year incidence for CG in at least one eye appeared to be correlated to age at baseline. Reduction of endothelial cell density for corneas with CG at baseline was found [CI (0.95)-132 ± 94]. CONCLUSION The cumulative 7-year incidence of primary central CG for a middle-aged and older Caucasian population without history of potentially confounding eye disease has been established. Women tend to have higher incidence if onset occurs at middle age. If CG is present, the cell density and the cell size variation decrease within a 7-year period.
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Grixti A, Sadri M, Datta AV. Uncommon ophthalmologic disorders in intensive care unit patients. J Crit Care 2012; 27:746.e9-22. [PMID: 22999481 DOI: 10.1016/j.jcrc.2012.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/08/2012] [Accepted: 07/10/2012] [Indexed: 11/18/2022]
Abstract
Ophthalmologic complications are frequently encountered in intensive care unit (ICU) patients (Grixti et al. Ocul Surf 2012;10(1):26-42). However, eye care is often overlooked in the critical care setting or just limited to the ocular surface because treatment is focussed on the management of organ failures. Lack of awareness about other less common intraocular sight-threatening conditions may have a devastating effect on the patient's vision. To identify specific, frequently missed uncommon ocular disorders in ICU, a literature review using the keywords "Intensive Care," "Eye care," "ITU," "ICU," "Ophthalmological disorders," "Eye disorders" was performed. The databases of CINAHL, PuBMed, EMBASE, and Cochrane library were searched. The higher quality studies are summarized in the table with statements of methodology to clarify the level of evidence. The most prevalent ophthalmologic disorders identified in critically ill subjects include exposure keratopathy, chemosis, and microbial keratitis. In addition, uncommon eye disorders reported in ICU include metastatic endogenous endophthalmitis, acute primary angle closure, ischemic optic neuropathy, pupil abnormalities, vascular occlusions, and rhino-orbital cerebral mucormycosis. Early diagnosis and effective treatment will help to prevent visual loss.
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Adekoya BJ, Ayanniyi AA, Adepoju FG, Omolase CO, Owoeye JF. Minimising corneal scarring from the use of harmful traditional eye remedies in developing countries. NIGERIAN QUARTERLY JOURNAL OF HOSPITAL MEDICINE 2012; 22:138-142. [PMID: 23175915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Corneal scarring is the fourth largest cause of blindness globally, and a much more prominent factor in developing countries. Blindness from corneal scarring is largely a preventable phenomenon, and is capable of causing significant morbidity that can last for a lifetime. A significant proportion of these cases are caused by the use of harmful traditional eye medicines/remedies, and are used and prescribed by friends, relatives and traditional healers, with widespread use especially in developing countries. Use of traditional remedies can also cause harm indirectly by causing delays before seeking medical treatment. Reducing corneal scarring from the use of harmful traditional medicine is through a combination of approaches with the key strategies being community diagnosis, education, participation, and intervention, with provision of basic eye care integrated into the primary health care of the community. Collaboration with traditional healers in the community is also another approach that has been found to be useful.
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Zemba M, Anghel G, Selaru D, Stefan C, Armegioiu M, Manole H. [Corneal transplantation activity in Eye Department of Central Military Emergency Universitary Hospital in 2011]. OFTALMOLOGIA (BUCHAREST, ROMANIA : 1990) 2012; 56:75-78. [PMID: 23424768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Ghaznawi N, Virdi A, Dayan A, Hammersmith KM, Rapuano CJ, Laibson PR, Cohen EJ. Herpes zoster ophthalmicus: comparison of disease in patients 60 years and older versus younger than 60 years. Ophthalmology 2011; 118:2242-50. [PMID: 21788078 DOI: 10.1016/j.ophtha.2011.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 04/03/2011] [Accepted: 04/04/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients aged <60 years versus patients aged ≥60 years at the time of diagnosis. DESIGN Retrospective chart review of all 112 patients presenting for management of HZO from January 1, 2008 to December 31, 2008. PARTICIPANTS A total of 112 patients (58 aged <60 years and 54 aged >60 years) at the time of HZO onset. INTERVENTIONS Anterior segment complications, treatments, and surgical procedures were documented at 3 months, 6 months, and 1 year, and then annually for the remainder of the follow-up period. MAIN OUTCOME MEASURES Intraocular pressure, inflammation, steroid use, surgical procedures, anterior segment complications, post-herpetic neuralgia, and delayed herpes zoster pseudodendrites. RESULTS Equal numbers of patients were affected with HZO in the younger and older age groups (51.8%, n = 58 vs. 48.2%, n = 54, respectively, P = 0.69). The most common decade of HZO onset was between 50 and 59 years. Younger patients were more likely to be healthy compared with older patients (P = 0.05). Delayed herpes zoster pseudodendrites were more common in the younger patients (36.7% vs. 16.7%, P = 0.03). The mean number of flares per patient-years was significantly higher in the younger patients (z test, P = 0.024). Post-herpetic neuralgia, neurotrophic keratopathy, and secondary infectious keratitis were more frequent in the older patients (P = 0.05). Prevalence of corneal perforation, corneal thinning, cataract formation, and glaucoma was similar between the 2 groups. Most patients in both groups (84.2% of younger patients and 89.5% of older patients) were taking topical steroids 3 years after referral for HZO. CONCLUSIONS Herpes zoster ophthalmicus affects individuals aged younger than and older than 60 years in similar numbers, with the most common decade of onset between age 50 and 59 years. Younger patients had more episodes of delayed pseudodendritiform keratitis and flares of inflammation compared with older patients, who had more problems related to neurotrophic keratopathy. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Miyake T, Kamiya K, Amano R, Shimizu K. [Corneal astigmatism before cataract surgery]. NIPPON GANKA GAKKAI ZASSHI 2011; 115:447-453. [PMID: 21706838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To investigate the distribution of corneal astigmatism, and the relationship of astigmatism to the patients' age in a large number of pre-cataract surgery patients. MATERIALS AND METHOD We retrospectively examined 12428 eyes of 7187 patients (5396 eyes of men, 7032 eyes of women) who underwent cataract surgery at Kitasato University Hospital from April, 2002 to September, 2009. The mean patients' age at the time of surgery was 69.9 +/- 12.1 years. We determined corneal astigmatism using an Auto Refract Keratometer ARK-700A, a RKT-7700 (Nidek), a RK-F1 (Canon) and a Retinomax K-plus2(Righton). We carried out these measurements at least three times for each patient, and the average values were used for analysis. RESULTS The mean corneal astigmatism was 1.02 +/- 0.81 D (0 to 14.75 D). The percentage of 1 D or less of corneal astigmatism was 63.6%, that of more than 1 D and 1.5 D or less was 20.9%, that of more than 1.5 D and 2 D or less was 7.4%, that of more than 2 D and 2.5 D or less was 3.8% and that of more than 2.5 D and 3 D or less was 1.8%. Neither significant laterality nor age difference in corneal astigmatism were found. The prevalence of with-the-rule astigmatism (WTR) was common in young population, whereas the prevalence of against-the-rule astigmatism(ATR) increased in the older population, whereas the prevalence of oblique astigmatism remains unchanged. CONCLUSIONS Approximately two thirds of the preoperative patients had 1 D or less corneal astigmatism, and the remaining one third had over 1 D corneal astigmatism. The frequency of WTR was greater at a younger age, and that of ATR, at an older age.
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Higa A, Sakai H, Sawaguchi S, Iwase A, Tomidokoro A, Amano S, Araie M. Prevalence of and Risk Factors for Cornea Guttata in a Population-Based Study in a Southwestern Island of Japan. ACTA ACUST UNITED AC 2011; 129:332-6. [PMID: 21402991 DOI: 10.1001/archophthalmol.2010.372] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
BACKGROUND Trachoma remains a significant cause of blindness in many parts of the world. The major route to blindness involves upper lid entropion leading to trachomatous trichiasis (TT), which promotes progressive corneal opacification. The provision of surgery to correct TT in the populations most severely affected is a major challenge for the global effort to eliminate trachoma blindness by the year 2020. Most attention has focused on increasing the quantity of TT surgery performed, and large numbers of non-doctor operators have been trained to this end. Surgical audit by those performing TT surgery is not a routine part of any national trachoma control programme, and no effective mechanism exists for identifying surgeons experiencing poor outcomes. The authors propose a methodology for surgical audit at the level of the individual surgeon based on Lot Quality Assurance. METHODS A set number of patients operated on previously for upper eyelid TT are examined to detect the recurrence of TT. The number of recurrent cases found will lead to categorisation of the TT surgeon to either 'high recurrence' or 'low recurrence' with reasonable confidence. The threshold of unacceptability can be set by individual programmes according to previous local studies of recurrence rates or those from similar settings. CONCLUSIONS Identification of surgeons delivering unacceptably high levels of recurrent TT will guide managers on the need for remedial intervention such as retraining.
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Xu L, Zheng DY. [Investigation of corneal astigmatism in phacoemulsification surgery candidates with cataract]. [ZHONGHUA YAN KE ZA ZHI] CHINESE JOURNAL OF OPHTHALMOLOGY 2010; 46:1090-1094. [PMID: 21211222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate the characters of corneal astigmatism in cataract surgery candidates. METHODS IOLMaster 5.0 was adopted in this study to measure preoperative corneal keratometry. The first suffered eye was taken as the observed eye when both eyes were involved. Descriptive statistics of keratometric cylinder data were analyzed. The mean of corneal astigmatism, distribution of astigmatism and the cumulated distribution were calculated. The relationship between age, axial length and astigmatism was analyzed respectively. The symmetry of binocular astigmatism was also studied. RESULTS Preoperative keratometric data were obtained from 1389 patients (1389 eyes) with age related cataract (mean age 67.75 years, range from 40 to 79 years). The median of astigmatism was 0.84 D (0.12-4.36 D). The percentage of corneal astigmatism of 1.0 diopters (D) or higher was 32.9% (457 eyes), of which 243 eyes (53.2%) were against-the-rule (ATR) astigmatism. With aging, the amount of ATR astigmatism was increasing. Axial length was not correlated with the amount of astigmatism (r=0.179, P=0.203). Corneal astigmatism was mirror symmetry in both eyes of one person. CONCLUSIONS Astigmatism, especially mild astigmatism, was common in patients with cataract, which suggests the importance of astigmatism correction. The symmetry of astigmatism should be considered when both eyes need cataract surgery. Axial length is not related to astigmatism, indicating that the measurement and correction of astigmatism are important even in emmetropia eyes.
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Godeiro KD, Coutinho AB, Pereira PR, Fernandes BF, Cassie A, Burnier MN. Histopathological Diagnosis of Corneal Button Specimens: An Epidemiological Study. Ophthalmic Epidemiol 2009; 14:70-5. [PMID: 17464853 DOI: 10.1080/09286580600954330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the most common histopathological diagnosis of corneal specimens from penetrating keratoplasty (PKP). METHODS The records of 500 corneal specimens submitted to biopsy at the Henry Witelson Ocular Pathology Laboratory, Montreal, Canada, from 1999 to 2004 were reviewed. Age, sex, clinical indications, and histopathological findings were analyzed. RESULTS Chronic keratitis (45.6%) was the most common pathological diagnosis, followed by corneal edema (25.8%), dystrophy (12.8%), keratoconus (KC) (9.2%), acute keratitis (5.6%), and degeneration (1.0%). Among the specimens with chronic keratitis, regraft was the most common clinical indication (39.0%). In the group of acute keratitis, ulcerative condition was the leading cause (75,0%). Fuchs' endothelial dystrophy represented 79.7% of the clinical diagnoses in the group of corneal dystrophies. The median patient age was 70-79 years, and the gender distribution was nearly symmetric. CONCLUSION The present study is important for determining the most common histopathological diagnoses of corneal button specimens and the correlation with the age, gender, and clinical indications of PKP.
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Foran S, Wang JJ, Mitchell P. Causes of visual impairment in two older population cross-sections: The Blue Mountains Eye Study. Ophthalmic Epidemiol 2009; 10:215-25. [PMID: 14628964 DOI: 10.1076/opep.10.4.215.15906] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To describe the causes of bilateral and unilateral blindness and visual impairment in two cross-sections of an older Australian population 6 years apart. METHODS The Blue Mountains Eye Study examined 3654 persons aged 49-97 years during 1992-1994 (population cross-section 1). Cohort survivors (2335) and 1174 persons who moved to the area or reached an eligible age were examined during 1997-2000, a total of 3509 persons (population cross-section 2). LogMAR visual acuity was measured after standardized refraction. Blindness and visual impairment were respectively defined by visual acuity <6/60 and <6/12. Causes were determined for the two temporal cross-sections. RESULTS Age-related macular degeneration (AMD) was the principal cause of bilateral and unilateral non-correctable blindness in both cross-sections. AMD caused 77% of bilateral blindness in Cross-section 1 and 50% in Cross-section 2. Cataract, glaucoma, corneal and neurological disease were next equally frequent causes (6% each) of bilateral blindness in Cross-section 1. In Cross-section 2, cataract ranked as the third most frequent principal cause (10%) after other retinal diseases (40%). The proportion of unilateral blindness with AMD as principal cause was very similar (around one-third of cases) in the two cross-sections; while in Cross-section 2 blindness was less frequently caused by cataract (19% vs. 13%). Cataract was the principal cause of both bilateral and unilateral visual impairment, responsible for 50% of bilateral (better eye) and 35-40% of unilateral (worse eye) impairment, with slightly lower rates found in Cross-section 2 than in Cross-section 1. AMD was consistently the second most frequent cause, causing one-third of bilateral and one-fifth of unilateral visual impairment. CONCLUSIONS These data indicate a relative stable pattern of causes for blindness and visual impairment, with AMD and cataract, respectively, dominating these two levels.
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Abstract
Corneal disease is one of the major causes of blindness worldwide. Removal of the damaged cornea and transplant of donated tissue is often the only option available to patients to improve and restore vision. This paper discusses corneal transplant with consideration given to penetrating keratoplasty (PK), a traditional full thickness corneal transplant and three other surgical techniques that offer an alternative to the traditional PK surgery: deep anterior lamellar keratoplasty (DALK), deep lamellar endothelial keratoplasty (DLEK) and limbal stem cell transplant.
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Madaras Z, Ferencz A, Pop D, Horváth K, Módis L. Corneal pathology and indications for corneal transplant at the Tg. Mures Ophthalmology Clinic. OFTALMOLOGIA (BUCHAREST, ROMANIA : 1990) 2009; 53:79-82. [PMID: 20361656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED The purpose of this study was to evaluate the incidence of corneal pathology that presents indication for cornea/transplant, treatment and follow-up of these patients. MATERIALS AND METHODS A retrospective analysis has been undertaken at the Tg. Mures Ophthalmology Hospital. In the study we have included all patients who had corneal pathology with intact deeper ocular structures. We have examined the treatment of these cases and their admittance to corneal transplantation. RESULTS In 2008 in 99 cases of the 3246 hospitalized patients such a corneal condition has been described that presented indication for corneal transplantation. Most common causes were corneal leucomas, corneal ulcers, bullous keratopathy and corneal dystrophies and degenerations. Fourteen patients tried to benefit from corneal transplant abroad financed by the National Health Insurance Office; others went on their own expense. All together four patients appeared for postoperative control at our Hospital. CONCLUSIONS We have found 99 cases of corneal transplant indication at our Hospital's patients and only a fraction of them have undergone surgery. We can point out a very low level of admittance and a great need for a regional corneal transplantation centers.
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Onyekwe LO. Factors affecting the visual outcome in hyphema management in Guinness Eye Center Onitsha. Niger J Clin Pract 2008; 11:364-367. [PMID: 19320412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND This study aims of determining the complications, outcome of hyphema treatment and recommend ways of enhancing good visual outcome. METHOD The records of all cases of hyphema seen from 1st January 2001 to 31st December 2005 were reviewed retrospectively. The variables analyzed were the biodata of all the patients, the agents causing hyphema, associated injuries and complications. Visual acuity at presentation, discharge and last visit was analyzed. RESULTS Seventy four patients that had hyphema were reviewed. The male:female ratio was 3.5:1. Trauma was predominantly main cause of hyphema. The common agents of injury include whip (23.2%) and fist (18.8%). The common complications were secondary glaucoma (52.5%), corneal siderosis (30.0%) and rebleeding (10%). Visual outcome is related to time ofpresentation, complications and treatment. Significant improvement was achieved following treatment. CONCLUSION Hyphema is a common complication of eye injuries. It is commonly associated with other eye injuries like vitreous haemorrhage and cataract. Common complications include secondary glaucoma, corneal siderosis and rebleeding. Visual outcome is dependent on time of presentation, severity and nature of complications. Visual outcome can be improved by early presentation and detection of complications and appropriate treatment.
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Mutonen NV. [Methods for reducing traumatism of the posterior corneal epithelium during ultrasound phacoemulsification]. Vestn Oftalmol 2008; 124:53-56. [PMID: 18488477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
[Methods for reducing traumatism of the posterior corneal epithelium during ultrasound phacoemulsification]
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Zarranz Ventura J, De Nova E, Moreno-Montañés J. [Corneal manifestations in systemic diseases]. An Sist Sanit Navar 2008; 31 Suppl 3:155-170. [PMID: 19169303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Systemic diseases affecting the cornea have a wide range of manifestations. The detailed study of all pathologies that cause corneal alteration is unapproachable, so we have centered our interest in the most prevalent or characteristic of them. In this paper we have divided these pathologies in sections to facilitate their study. Pulmonar and conective tissue (like colagen, rheumatologic and idiopathic inflamatory diseases), dermatologic, cardiovascular, hematologic, digestive and hepatopancreatic diseases with corneal alteration are described. Endocrine and metabolic diseases, malnutrition and carential states are also studied, as well as some otorhinolaryngologic and genetic diseases that affect the cornea. Finally, a brief report of ocular toxicity induced by drugs is referred.
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Randleman JB, Woodward M, Lynn MJ, Stulting RD. Risk Assessment for Ectasia after Corneal Refractive Surgery. Ophthalmology 2008; 115:37-50. [PMID: 17624434 DOI: 10.1016/j.ophtha.2007.03.073] [Citation(s) in RCA: 468] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 03/30/2007] [Accepted: 03/30/2007] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To analyze the epidemiologic features of ectasia after excimer laser corneal refractive surgery, to identify risk factors for its development, and to devise a screening strategy to minimize its occurrence. DESIGN Retrospective comparative and case-control study. PARTICIPANTS All cases of ectasia after excimer laser corneal refractive surgery published in the English language with adequate information available through December 2005, unpublished cases seeking treatment at the authors' institution from 1998 through 2005, and a contemporaneous control group who underwent uneventful LASIK and experienced a normal postoperative course. METHODS Evaluation of preoperative characteristics, including patient age, gender, spherical equivalent refraction, pachymetry, and topographic patterns; perioperative characteristics, including type of surgery performed, flap thickness, ablation depth, and residual stromal bed (RSB) thickness; and postoperative characteristics including time to onset of ectasia. MAIN OUTCOME MEASURES Development of postoperative corneal ectasia. RESULTS There were 171 ectasia cases, including 158 published cases and 13 unpublished cases evaluated at the authors' institution. Ectasia occurred after LASIK in 164 cases (95.9%) and after photorefractive keratectomy (PRK) in 7 cases (4.1%). Compared with controls, more ectasia cases had abnormal preoperative topographies (35.7% vs. 0%; P<1.0x10(-15)), were significantly younger (34.4 vs. 40.0 years; P<1.0x10(-7)), were more myopic (-8.53 vs. -5.09 diopters; P<1.0x10(-7)), had thinner corneas before surgery (521.0 vs. 546.5 microm; P<1.0x10(-7)), and had less RSB thickness (256.3 vs. 317.3 microm; P<1.0x10(-10)). Based on subgroup logistic regression analysis, abnormal topography was the most significant factor that discriminated cases from controls, followed by RSB thickness, age, and preoperative corneal thickness, in that order. A risk factor stratification scale was created, taking all recognized risk factors into account in a weighted fashion. This model had a specificity of 91% and a sensitivity of 96% in this series. CONCLUSIONS A quantitative method can be used to identify eyes at risk for developing ectasia after LASIK that, if validated, represents a significant improvement over current screening strategies.
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Prabhasawat P, Trethipwanit KO, Prakairungthong N, Narenpitak S, Jaruroteskulchai S, Anantachai J. Causes of corneal blindness: a multi-center retrospective review. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND = CHOTMAIHET THANGPHAET 2007; 90:2651-2657. [PMID: 18386716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess prevalence and causes of corneal blindness in four hospitals in Thailand and to compare the causes between hospitals. MATERIAL AND METHOD A retrospective chart review of six hundred and sixty four patients records with best-corrected visual acuity not better than 6/60 in at least one eye due to corneal disease in Siriraj, Mettapracharak, Sappasitthiprasong and Banmee Hospitals in a one-year period were reviewed. The collected data included age, sex, laterality, causes of corneal blindness, and prognosis. RESULTS Seven hundred and sixty nine eyes with corneal blindness and a median age of 55.0 years were reviewed Leading causes of cornea blindness were corneal infection (35.6%), surgical bullous keratopathy (27.8%), and trauma (14.0%). The prevalence at Siriraj Hospital was 1.7% (498/28,728 patients). Most of the treatable cases (84.6%) underwent penetrating keratoplasty procedures and 73% of patients had a chance of recovery. CONCLUSION Corneal infection and surgical bullous keratopathy were the leading causes of corneal blindness.
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Sharma N, Prakash G, Titiyal JS, Tandon R, Vajpayee RB. Pediatric keratoplasty in India: indications and outcomes. Cornea 2007; 26:810-3. [PMID: 17667614 DOI: 10.1097/ico.0b013e318074ce2e] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To analyze the indications and outcomes of pediatric corneal transplantation surgery in a tertiary eye care center in the developing world. METHODS In this longitudinal, retrospective study involving continuous cases, the records of 168 eyes of 154 children undergoing keratoplasty at a tertiary care center's specialized keratoplasty clinic during a 7-year period (1998-2004) were reviewed. The demography, etiology of opacification, visual acuity, and other findings were recorded. Intraoperative and postoperative details were reviewed. Major postoperative outcomes analyzed were visual acuity, graft survival, causes of graft failure, and follow-up duration. RESULTS Infectious keratitis (43%) was the most common indication for keratoplasty, followed by congenital glaucoma (16.6%) and corneal trauma (11.2%). Overall 77% graft survival was seen at 36 months, and better graft outcome was associated with younger age and longer regular follow-up. Postoperatively, a best-corrected visual acuity (BCVA) > 20/200 could be achieved in only 30.1% of eyes at the last follow-up. Graft failure was seen in 18.4% of eyes, with graft infection being the most frequent cause (50%). Moreover, graft infection was the most common cause of graft failure in all age groups. CONCLUSIONS In the developing world, infectious keratitis is the most common indication for pediatric keratoplasty and the most frequent cause of its failure.
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Sitorus RS, Abidin MS, Prihartono J. Causes and temporal trends of childhood blindness in Indonesia: study at schools for the blind in Java. Br J Ophthalmol 2007; 91:1109-13. [PMID: 17709582 PMCID: PMC1954904 DOI: 10.1136/bjo.2006.110445] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To ascertain the causes of blindness and severe visual impairment (BL/SVI) in schools for the blind in Java, to identify preventable and treatable causes and to evaluate temporal trends in the major causes. METHODS From a total of 504 students, 479 were examined. Data was collected using a modified World Heath Organization Prevention of Blindness (WHO/PBL) eye examination record for children. RESULTS The majority of the students (95%) were blind and 4.6% were severely visually impaired. The major anatomical site of BL/SVI was whole globe in 35.9%, retina in 18.9%, lens in 16.4% and cornea in 16.1%. The major underlying aetiology of BL/SVI was undetermined/unknown in 32.7% (mainly microphthalmia, anterior segment dysgenesis and cataract), hereditary factors 31.9% (mainly retinal dystrophies), and childhood disorders 28.5%. Avoidable causes of BL/SVI accounted for 59.9% of the total students, whereas measles blindness was the underlying condition for 23.1% of the preventable causes; cataract and glaucoma accounted for 15.5% and 8.2% of the treatable causes, respectively. Exploration on trends of SVI/BL among two different age groups <16 years and > or = 16 years suggested that childhood disorders and corneal factors have declined, while hereditary disorders have increased. Optic nerve disorder, although not counted as a major cause of blindness, seems to be on the increase. CONCLUSIONS More than half of the BL/SVI causes are potentially avoidable. Cataract and corneal disorders related to measles or vitamin A deficiency were the major treatable and preventable causes. Declining proportions of childhood factors and corneal disorders over a period of 10-20 years could reflect improved vitamin A supplementation and measles vaccination coverage in Indonesia. This finding, and the increased proportion of hereditary disease causes, could suggest improving levels of socioeconomic development and health care services.
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Abstract
PURPOSE To analyze leading indications for penetrating keratoplasty (PKP) in north China and changing trends in them. METHODS We retrospectively reviewed the records of patients who underwent PKP at Shandong Eye Institute from January 1997 to December 2002. Infectious keratitis (fungal, bacterial, and acanthamoeba), herpes simplex keratitis (HSK), corneal scarring, keratoconus, bullous keratopathy, regrafting, corneal dystrophy and degeneration, and others were included in the indications for PKP. Initial diagnoses and causes of regrafting were recorded, as well as the related intraocular surgeries for bullous keratopathy. RESULTS A total of 1702 patients (1702 eyes) were included in this study. The leading indications for PKP were infectious keratitis (31%), followed by HSK (18%), corneal scarring (16%), keratoconus (13%), bullous keratopathy (7%), regrafting (5%), and corneal dystrophy and degeneration (4%). Percentage of PKP for keratoconus and bullous keratopathy increased significantly during the 6 years, contrary to HSK and corneal scarring. Fungal infections accounted for 66% of infectious keratitis. Of 118 bullous keratopathy cases, 90 (76%) were associated with cataract surgery. The leading initial diagnoses of regrafting were corneal burns (25%), HSK (23%), and infectious keratitis (14%); the major causes included immune rejection (61%), graft infection (14%), and recurrence of HSK (10%). CONCLUSIONS Infectious keratitis remains the most common indication for PKP in north China. Moreover, there is an increasing trend in the percentage of PKP for keratoconus and bullous keratopathy.
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Chalmers RL, McNally JJ, Schein OD, Katz J, Tielsch JM, Alfonso E, Bullimore M, O'Day D, Shovlin J. Risk factors for corneal infiltrates with continuous wear of contact lenses. Optom Vis Sci 2007; 84:573-9. [PMID: 17632304 DOI: 10.1097/opx.0b013e3180dc9a12] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe the factors associated with symptomatic corneal infiltrates in a postmarket surveillance study of continuous wear contact lenses. METHODS Patients intending to wear lotrafilcon A lenses continuously for 30 days and nights were registered in a 1-year study at 131 clinical sites. A self-administered questionnaire was used to gather demographic and other data at baseline. The severity of the incidence of corneal infiltrative events during the year-long study was graded by an independent adjudication committee. RESULTS Of 6245 lens wearers, 163 were reported to have symptomatic corneal infiltrative events (2.6%). In 159 wearers, the infiltrates were judged to be lens-related (2.5%). Age < or =25 years and >50 years was significantly associated with the development of corneal infiltrates (< or =25 years OR = 1.75, 95% CI = 1.24-2.48 and >50 years OR = 2.04, 95% CI = 1.40-2.98). Ametropia of > or =5.00 D was significantly associated with corneal infiltrates (OR = 1.60, 95% CI = 1.08-2.37). Study participants who typically wore lenses for >21 consecutive days and nights were significantly less likely to have infiltrates than those who wore lenses for fewer consecutive days and nights (OR = 0.43, 95% CI = 0.24-0.75). Smoking concurrent with contact lens wear was weakly associated with corneal infiltrates (OR = 1.47, CI = 0.99-2.18). CONCLUSIONS Patient age, degree of refractive error, and failure to achieve the intended wearing schedule were associated with development of symptomatic corneal infiltrative events.
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Allali J, Roche O, Monnet D, Brezin A, Renard G, Dufier JL. [Anhidrotic ectodermal dysplasia: "congenital ameibomia"]. J Fr Ophtalmol 2007; 30:525-8. [PMID: 17568347 DOI: 10.1016/s0181-5512(07)89634-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anhidrotic ectodermal dysplasia is a congenital, generally X-linked dermatosis that associates facial dysmorphy, short stature, and severe blepharitis. The anomalies of the skin are epidermic abnormalities; reduction of the glands of the derm, particularly the sweat glands, explaining the hypohidrosis; onychodysplasia; trichodysplasia; and abnormal dentition. The ophthalmologic manifestations are palpebral anomalies with a reduction in or an absence of Meibomian glands, dysfunction of the Moll and Zeis glands, leading to chronic squamous blepharitis and lacrimal punctal atresia. These anomalies result in severe attacks of the ocular surface, developing during the second decade, which are often invalidating and require a rigorous follow-up to avoid corneal complications.
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