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Yeh TC, Hsu CC, Lu YH, Chen YR, Niu DM, Lin PY. Novel Manifestation of Corneal Dystrophy After Keratorefractive Surgery. Cornea 2024; 43:404-408. [PMID: 37506370 DOI: 10.1097/ico.0000000000003355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE This study aimed to report cases of bilateral corneal Bowman layer deposits in 4 patients with a history of keratorefractive surgery. To our knowledge, this condition has not previously been reported and should be distinguished from granular corneal dystrophy type 2 and other corneal dystrophies. METHODS We reviewed all available medical records that were collected between January 2010 and December 2021 at a tertiary referral center and performed whole-exome sequencing to provide diagnostic information. RESULTS Four patients exhibited similar bilateral corneal deposits that were observed more than 10 years after keratorefractive surgery. The patients' ages ranged from 36 to 53 years; 3 of the 4 patients were female. Three patients received laser in situ keratomileusis surgery, and 1 received radial keratotomy. All 4 patients denied having a family history of ocular diseases and reported an uneventful postoperative course. On examination, the best-corrected visual acuity ranged from 6/10 to 6/6 in all 4 patients. Slit-lamp examination revealed bilateral superficial corneal deposits involving the central cornea, and anterior segment optical coherence tomography revealed hyperreflective deposits located in the Bowman layer. Such unique manifestations suggested corneal dystrophy; thus, whole-exome sequencing was performed on all 4 patients. Only 1 patient exhibited a missense mutation in TGFBI . We further analyzed common de novo mutations to explore possible candidate genes associated with this presentation. CONCLUSIONS We report a rare entity of presumed corneal dystrophy with deposits located in the Bowman layer in 4 patients who had received keratorefractive surgery. Clarifying the underlying pathophysiology and genetic predisposition of this disease may aid in diagnosing and preventing potential complications after keratorefractive surgery.
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Affiliation(s)
- Tsai-Chu Yeh
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Hsiu Lu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; and
| | - Yun-Ru Chen
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; and
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; and
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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Li A, Liu Z, Lin M, Gong Q, Wei L, Lu F, Hu L. Changes in Corneal Epithelial Thickness in Different Areas After Femtosecond Laser-Assisted LASIK in Patients With High Astigmatism. J Refract Surg 2024; 40:e239-e244. [PMID: 38593260 DOI: 10.3928/1081597x-20240311-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE To explore changes in corneal epithelial thickness (CET) after femtosecond laser-assisted laser in situ keratomileusis in patients with high astigmatism. METHODS CET was measured at every intersection of the concentric circles and specific axes using AngioVue optical coherence tomography (Angio-OCT) preoperatively and 1 month postoperatively. The average thickness of corneal central, paracentral, and peripheral regions was the mean of the points within the central 2, 2 to 5, and 5 to 7 mm areas, respectively. Correlation analysis was performed to investigate the association between CET along different axes and other preoperative and postoperative parameters. RESULTS Forty-two eyes of 28 patients were included. CET along the astigmatic (K1) and perpendicular (K2) axes in the central and paracentral areas increased (P < .001), whereas that along the K2 axis decreased in the peripheral area 1 month postoperatively (P = .001). The amount of CET change in the peripheral area between the K1 and K2 axes was significantly different (P < .001). In the central area, the change in CET along the K2 axis was positively correlated with ablation depth (r = 0.315, P = .042) and negatively with refractive power after surgery (r = -0.347, P = .024). In the peripheral area, the changes in CET along both K1 and K2 axes were negatively correlated with ablation depth (r = -0.431, P = .004; r = -0.387, P = .011, respectively). CONCLUSIONS Epithelial modeling differed between the different astigmatism axes after refractive surgery. The compensatory response of the corneal epithelium is more pronounced along the steeper axis. [J Refract Surg. 2024;40(4):e239-e244.].
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Zhao L, Jia Y, Zhao C, Li H, Wang F, Dong M, Liu T, Zhang S, Zhou Q, Shi W. Ocular surface repair using decellularized porcine conjunctiva. Acta Biomater 2020; 101:344-356. [PMID: 31706041 DOI: 10.1016/j.actbio.2019.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
Abstract
The primary functions of the conjunctiva embody ocular surface protection and the maintenance of the tear film equilibrium. Severe conjunctival defects such as symblepharon may impair the integrity of ocular surface and cause loss of visual functions. Here we report the use of a decellularized porcine conjunctiva (DPC) for conjunctival reconstruction in rabbit models and in clinic. Our results show that the major xenoantigens are efficiently removed, while abundant matrix components and integrated microstructures are well preserved in the DPC. These characteristics provide mechanical support and favorable histocompatibility for repairing damaged conjunctiva. The DPC application has demonstrated enhanced transplant stability and improved epithelial regeneration in severe ocular surface damage comparing to those of amniotic membrane (AM), the most frequently applied matrix for ocular surface reconstruction nowadays. In order to test the DPC performance in clinic, three patients with pterygium and one patient with symblepharon underwent transplant with DPC. The grafts in all cases were completely re-epithelized and no graft melt or fibroplasia were observed. These results suggest that the strategy we developed is feasible and effective for conjunctival reconstruction and ocular surface repair. STATEMENT OF SIGNIFICANCE: In this study, we adopted an innovative approach to prepare decellularized porcine conjunctiva (DPC). The intricate conjunctiva-specific structures and abundant matrix components were preserved in DPC, which offers favorable mechanical properties for graft. DPC has shown positive effects in ocular surface repair, which has been proven particularly in a rabbit model with severe symblepharon. Reconstructed conjunctiva by DPC exhibited epithelial heterogeneity, extremely resembling that of native conjunctiva. In addition, results from clinical studies were encouraging for pterygium and symblepharon and clinical application of DPC is promising.
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Affiliation(s)
- Long Zhao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266000, China
| | - Yanni Jia
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China
| | - Can Zhao
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China
| | - Hua Li
- Department of Ophthalmology, Qilu Medical College of Shandong University, Jinan 250000, China
| | - Fuyan Wang
- Department of Ophthalmology, Qilu Medical College of Shandong University, Jinan 250000, China
| | - Muchen Dong
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China
| | - Ting Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266000, China; Qingdao Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266000, China
| | - Songmei Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266000, China
| | - Qingjun Zhou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266000, China.
| | - Weiyun Shi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266000, China; Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China.
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Cho Y, Hieda O, Wakimasu K, Yamamura K, Yamasaki T, Nakamura Y, Sotozono C, Kinoshita S. Multiple Linear Regression Analysis of the Impact of Corneal Epithelial Thickness on Refractive Error Post Corneal Refractive Surgery. Am J Ophthalmol 2019; 207:326-332. [PMID: 31128091 DOI: 10.1016/j.ajo.2019.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the influence of corneal epithelial thickness (CET) on the deviation from the targeted refraction (refractive error [RE]) post corneal refractive surgery. DESIGN Retrospective, single-center, cross-sectional study. METHODS This study involved 211 eyes of 211 patients who previously underwent laser-assisted in situ keratomileusis (LASIK) or epipolis LASIK for the correction of myopia and myopic astigmatism from August 2000 to May 2014 at the Baptist Eye Institute, Kyoto, Japan, and who subsequently underwent examination of CET via optical coherence tomography imaging of 17 zones (central: n = 1 zone, paracentral: n = 8 zones, and midperipheral: n = 8 zones) within a 6.0-mm-diameter area of the central cornea from April 2014 to February 2015. The relationship between CET and RE was evaluated using Spearman coefficient in 5 parameters: CET in the (1) central, (2) paracentral, and (3) midperipheral zones, and the difference between the (4) central and paracentral zones and the (5) central and midperipheral zones. The influence of CET on RE was evaluated in the CET parameter that showed a significant correlation with RE using multiple liner regression analysis. RESULTS The correlation coefficient with RE was (1) -0.238 (P < .01), (2) -0.172 (P < .05), (3) -0.002 (P = .98), (4) -0.186 (P < .01), and (5) -0.266 (P < .01), respectively. Multiple liner regression analysis revealed that the difference of mean CET between the central and midperipheral zones had a significant influence on RE (β coefficient = -0.028, P < .01). CONCLUSIONS The difference between CET at the central and midperipheral zones may play a role in the final RE post corneal refractive surgery.
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Affiliation(s)
- Yuko Cho
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Osamu Hieda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | - Yo Nakamura
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Friehmann A, Mimouni M, Nemet AY, Sela T, Munzer G, Kaiserman I. Risk Factors for Epithelial Ingrowth Following Microkeratome-Assisted LASIK. J Refract Surg 2018; 34:100-105. [PMID: 29425388 DOI: 10.3928/1081597x-20180105-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the incidence and risk factors associated with epithelial ingrowth following uncomplicated microkeratome-assisted LASIK. METHODS All patients who underwent microkeratome-assisted LASIK between January 2006 and December 2014 in a single surgical center were reviewed. Epithelial ingrowth cases were identified and associated factors were assessed. RESULTS Overall, 149 (0.49%) of 30,574 cases developed epithelial ingrowth. The epithelial ingrowth group was older compared to controls (35.3 ± 12.3 vs 31.7 ± 10.3 years, P = .001) and had a higher percentage of moderate to high hyperopia (13.7% vs 5.3%, P < .001), early postoperative flap slippage requiring flap repositioning (9.4% versus 2.8%, P < .001), or flap lifting for enhancement (48.6% vs 4.3%, P < .001), were treated with a smaller optic zone (6 mm) (37.7% vs 15.2%, P < .001), with a Moria M2 microkeratome (Moria SA, Antony, France) (70.1% vs 55.5%, P = .02), by low volume surgeons (n < 1,000) (5.8% vs 1.3%, P < .001), in a lower operating room temperature (22.3 ± 1.8 vs 22.8 ± 1.6, P = .005), and with a greater maximum ablation depth (67.3 ± 29.7 vs 57.3 ± 30.3, P < .001). There was a high incidence of epithelial ingrowth in the enhancement group compared to primary LASIK (4.8% vs 0.2%, P < .001). The time between treatments (primary and enhanced LASIK) was significantly greater in the epithelial ingrowth group (mean: 1,110 ± 870 vs 626 ± 662 days, P < .001). There was a significant rise in epithelial ingrowth rates as time between primary and enhancement LASIK increased, peaking at 4 to 5 years (P < .001). In multivariate analysis, flap lifting for enhancement (odds ratio [OR] = 19.5, P < .001), 6-mm optic zone (OR = 2.2, P < .001), moderate to severe hyperopia (OR = 2.4, P = .005), greater ablation depth (OR = 1.005, P < .001), and low volume surgeon (OR = 3.9, P = .01) were associated with epithelial ingrowth (total R2 = 15.4). CONCLUSIONS The potential risk factors described above may forewarn surgeons as to which individuals merit closer observation for this complication. [J Refract Surg. 2018;34(2):100-105.].
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Hardten DR, Fahmy MM, Vora GK, Berdahl JP, Kim T. Fibrin adhesive in conjunction with epithelial ingrowth removal after laser in situ keratomileusis: long-term results. J Cataract Refract Surg 2016; 41:1400-5. [PMID: 26287878 DOI: 10.1016/j.jcrs.2014.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/08/2014] [Accepted: 10/11/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the long-term results of fibrin adhesive use in the management of epithelial ingrowth after laser in situ keratomileusis (LASIK). SETTING Private practice, Minneapolis, Minnesota, and an academic medical center, Durham, North Carolina, USA. DESIGN Retrospective case series. METHODS Patients with a history of LASIK had epithelial ingrowth removal with mechanical debridement and fibrin glue application. Visual outcomes and the presence or absence of epithelial ingrowth were evaluated again after 3 months and at the last follow-up. The main outcome measures were recurrence of epithelial ingrowth and visual acuity. RESULTS Thirty-nine eyes of 38 patients were evaluated. After epithelial ingrowth removal and application of fibrin glue, 31 eyes (79.5%) had no recurrence of ingrowth at the final follow-up and 5 eyes (12.8%) had mild epithelial ingrowth not requiring removal. Three eyes (7.7%) had significant epithelial ingrowth at the 3-month follow-up that required subsequent removal and fibrin application. At the 3-month follow-up visit, 76.9% of eyes achieved 20/25 or better corrected distance visual acuity (CDVA) and 69.2% of eyes achieved 20/40 or better uncorrected distance visual acuity (UDVA). At the last follow-up visit (mean 26.6 ± 17.0 months [SD]), 84.6% of eyes had 20/25 or better CDVA and 74.4% of eyes had 20/40 or better UDVA. CONCLUSIONS Fibrin adhesive in conjunction with manual epithelial removal prevented a clinically significant recurrence of epithelial ingrowth in the majority of eyes. Larger randomized studies are needed to compare the success of this technique with that of others. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- David R Hardten
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA
| | - Mona M Fahmy
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA
| | - Gargi K Vora
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA
| | - John P Berdahl
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA
| | - Terry Kim
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA.
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Reversibility of topographic changes and visual symptoms induced by epithelial ingrowth post-LASIK: a case report. J Fr Ophtalmol 2014; 37:e149-51. [PMID: 25455559 DOI: 10.1016/j.jfo.2014.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/05/2014] [Accepted: 04/08/2014] [Indexed: 11/24/2022]
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Henry CR, Canto AP, Galor A, Vaddavalli PK, Culbertson WW, Yoo SH. Epithelial Ingrowth After LASIK: Clinical Characteristics, Risk Factors, and Visual Outcomes in Patients Requiring Flap Lift. J Refract Surg 2012; 28:488-92. [DOI: 10.3928/1081597x-20120604-01] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/22/2012] [Indexed: 11/20/2022]
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Abstract
PURPOSE To report a patient who presented an infectious keratitis 4 years after laser in situ keratomileusis (LASIK) without any other predisposing risk factor than the LASIK procedure itself. CASE REPORT We report a 32-year-old man operated by LASIK in January 2006 who presented with infectious keratitis in the OD in April 2010. Clinical examination showed a corneal abscess at 10-o'clock position in the interface and fibrin and Tyndall 4+ in the anterior chamber. Microbiological analysis identified Pseudomonas aeruginosa as the cause of infection. The patient was given ofloxacin, sulfate neomycin, polymyxin B, and prednisolone acetate to be used every 2 h. Treatment led to clinical improvement with resolution of corneal infiltrate. Keratitis with intact epithelium by Pseudomonas can occur up to 4 years after LASIK. CONCLUSIONS LASIK treatment is a predisposing factor for bacterial keratitis even years after surgery. This report demonstrates the importance of continued postoperative vigilance by patient and his/her clinician.
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A perfluoropolyether corneal inlay for the correction of refractive error. Biomaterials 2011; 32:3158-65. [PMID: 21306775 DOI: 10.1016/j.biomaterials.2011.01.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 01/12/2011] [Indexed: 11/24/2022]
Abstract
This study assessed the long-term biological response of a perfluoropolyether-based polymer developed as a corneal inlay to correct refractive error. The polymer formulation met chemical and physical specifications and was non-cytotoxic when tested using standard in vitro techniques. It was cast into small microporous membranes that were implanted as inlays into corneas of rabbits (n = 5) and unsighted humans (n = 5 + 1 surgical control) which were monitored for up to 23 and 48 months respectively. Overall, the inlays were well tolerated during study period with the corneas remaining clear and holding a normal tear film and with no increased vascularisation or redness recorded. Inlays in three human corneas continued past 48 months without sequelae. Inlays in two human corneas were removed early due to small, focal erosions developing 5 and 24 months post-implantation. Polymer inlays maintained their integrity and corneal position for the study duration although the optical clarity of the inlays reduced slowly with time. Inlays induced corneal curvature changes in human subjects that showed stability with time and the refractive effect was reversed when the inlay was removed. Outcomes showed the potential of a perfluoropolyether inlay as a biologically acceptable corneal implant with which to provide stable correction of refractive error.
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Management of Epithelial Ingrowth After Laser In Situ Keratomileusis on a Tertiary Care Cornea Service. Cornea 2010; 29:307-13. [PMID: 20098302 DOI: 10.1097/ico.0b013e3181b7f3c5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Horswill MA, Narayan M, Warejcka DJ, Cirillo LA, Twining SS. Epigenetic silencing of maspin expression occurs early in the conversion of keratocytes to fibroblasts. Exp Eye Res 2008; 86:586-600. [PMID: 18291368 DOI: 10.1016/j.exer.2008.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 12/10/2007] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
Abstract
Maspin, a 42 kDa non-classical serpin (serine protease inhibitor) that controls cell migration and invasion, is mainly expressed by epithelial-derived cells but is also expressed in corneal stromal keratocytes. Upon culture of stromal keratocytes in the presence of FBS, maspin is down-regulated to nearly undetectable levels by passage two. DNA methylation is one of several processes that controls gene expression during cell differentiation, development, genetic imprinting, and carcinogenesis but has not been studied in corneal stromal cells. The purpose of this study was to determine whether DNA methylation of the maspin promoter and histone H3 dimethylation is involved in the mechanism of down-regulation of maspin synthesis in human corneal stromal fibroblasts and myofibroblasts. Human donor corneal stroma cells were immediately placed into serum-free defined medium or cultured in the presence of FBS and passed into serum-free medium or medium containing FBS or FGF-2 to induce the fibroblast phenotype or TGF-beta1 for the myofibroblast phenotype. These cell types are found in wounded corneas. The cells were used to prepare RNA for semi-quantitative or quantitative RT-PCR or to extract protein for Western analysis. In addition, P4 FBS cultured fibroblasts were treated with the DNA demethylating agent, 5-aza-2'-deoxycytidine (5-Aza-dC), and the histone deacetylase inhibitor, trichostatin A (TSA). Cells with and without treatment were harvested and assayed for DNA methylation using sodium bisulfite sequencing. The methylation state of histone H3 associated with the maspin gene in the P4 fibroblast cells was determined using a ChIP assay. Freshly harvested corneal stromal cells expressed maspin but upon phenotypic differentiation, maspin mRNA and protein were dramatically down-regulated. Sodium bisulfite sequencing revealed that the maspin promoter in the freshly isolated stromal keratocytes was hypomethylated while both the P0 stromal cells and the P1 cells cultured in the presence of serum-free defined medium, FGF-2 and TGF-beta1 were hypermethylated. Down-regulation of maspin synthesis was also associated with histone H3 dimethylation at lysine 9. Both maspin mRNA and protein were re-expressed at low levels with 5-Aza-dC but not TSA treatment. Addition of TSA to 5-Aza-dC treated cells did not increase maspin expression. Treatment with 5-Aza-dC did not significantly alter demethylation of the maspin promoter but did demethylate histone H3. These results show maspin promoter hypermethylation and histone methylation occur with down-regulation of maspin synthesis in corneal stromal cells and suggest regulation of genes upon conversion of keratocytes to wound healing fibroblasts can involve promoter and histone methylation.
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Affiliation(s)
- Mark A Horswill
- Department of Biochemistry, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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13
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Davies JB, Randleman JB. Successful Delayed Surgical Revision of a Dislocated LASIK Flap. Ophthalmic Surg Lasers Imaging Retina 2008; 39:221-4. [DOI: 10.3928/15428877-20080501-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Maguen E, Maguen B, Regev L, Ljubimov AV. Immunohistochemical Evaluation of Two Corneal Buttons With Post-LASIK Keratectasia. Cornea 2007; 26:983-91. [PMID: 17721301 DOI: 10.1097/ico.0b013e3180de1d91] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine immunohistochemically 2 human corneal buttons after corneal transplantation for post-laser in situ keratomileusis (LASIK) keratectasia. METHODS Two ectatic corneas after penetrating keratoplasty and 2 postmortem control corneas from a patient after uncomplicated LASIK were used. Cryostat sections were stained by immunofluorescence for >30 extracellular matrix (ECM) components and proteinases. RESULTS The ratios of distance between LASIK flap interface and the upper epithelial layer to total corneal thickness were 0.27-0.34 in all cases. The whole flap interface was positive only for total and cellular fibronectin. Stromal types VI and XIV collagen, fibrillin-1, tenascin-C, and vitronectin were unchanged with no evidence of fibrosis. In ectasia cases, keratocytes adjacent to the flap did not express nidogens. Staining for type IV collagen alpha5 chain, nidogen-2, chains of laminin-8, and laminin-10 was weak and discontinuous in the epithelial basement membrane (EBM). Type IV collagen alpha1/alpha2 chains were found in the EBM of ectasia cases only. Matrix metalloproteinase (MMP)-10 showed increase in the epithelium, and MMP-3, in some keratocytes near the flap interface of ectatic corneas. Also, cathepsin F was seen at the flap margin only. Staining for limbal basal epithelial marker, alpha-enolase, was mostly absent in the ectatic cases, suggesting largely normal epithelial differentiation. CONCLUSIONS Abnormal EBM structure similar to that previously observed in keratoconus and bullous keratopathy and an increase in certain proteinases suggest ongoing EBM lysis and remodeling. Immunohistochemical staining for fibronectin may be used to reveal the position of flap interface.
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Affiliation(s)
- Ezra Maguen
- Ophthalmology Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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15
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Gooi P, Robinson JW, Brownstein S, Rocha G. Histologic and Ultrastructural Findings in a Case of Traumatic Graft Failure in Deep Lamellar Endothelial Keratoplasty. Cornea 2007; 26:853-7. [PMID: 17667621 DOI: 10.1097/ico.0b013e31806457db] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Few complications have been reported for deep lamellar endothelial keratoplasty (DLEK). Endothelial graft failure has rarely been disclosed as a complication. Although the histopathologic and ultrastructural analysis of a failed DLEK graft has been previously described, we are not aware of any reports of these features in a case of traumatic endothelial graft failure. METHODS We report a case of an 85-year-old man with Fuchs endothelial dystrophy who underwent DLEK for corneal decompensation after cataract extraction and intraocular lens implantation. The graft had dislocated by the fourth postoperative day and was repositioned the following day. Penetrating keratoplasty was performed 3 months later for gradually progressive intractable corneal edema. The excised cornea underwent histochemical, immunohistochemical, and ultrastructural analysis. RESULTS Marked endothelial loss resulting in corneal decompensation was diagnosed histopathologically. The graft-host interface line showed no substantial findings for the following histochemical and immunohistochemical stains: colloidal iron, alcian blue (pH 2.5), vimentin, epithelial membrane antigen (EMA), smooth muscle actin (SMA), anti-cytokeratin CAM 5.2, high-molecular-weight keratin, anti-cytokeratin AE1/AE3, and collagen 3. The cornea showed ultrastructural changes similar to, but more pronounced than, those observed in corneas after laser in situ keratomileusis. CONCLUSIONS This is the second described case of endothelial graft failure after DLEK. Histochemical and ultrastructural analysis revealed that the DLEK-operated cornea contained irregularities that may interfere with optical performance.
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Affiliation(s)
- Patrick Gooi
- Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada
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Muñoz G, Albarrán-Diego C, Sakla HF, Javaloy J, Alió JL. Transient light-sensitivity syndrome after laser in situ keratomileusis with the femtosecond laser. J Cataract Refract Surg 2006; 32:2075-9. [PMID: 17137986 DOI: 10.1016/j.jcrs.2006.07.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Accepted: 07/11/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the incidence of transient light-sensitivity syndrome (TLSS) after laser in situ keratomileusis (LASIK) with the femtosecond laser and to identify preventive strategies. SETTING Hospital NISA Virgen del Consuelo, Valencia, Spain. METHODS The first 765 eyes operated on with the 15 KHz femtosecond laser were prospectively analyzed for subjective complaints and clinical findings compatible with TLSS. Intraoperative settings, postoperative treatment, and development of complications were analyzed. RESULTS Overall, TLSS developed in 10 eyes (incidence 1.3%). However, the incidence decreased from 2.8% to 0.4% when aggressive topical steroids were used during the first 3 postoperative days. Postoperative interface inflammation and postoperative use of a low-dose topical steroid regimen were associated with a higher incidence of TLSS. CONCLUSIONS Transient light-sensitivity syndrome is a relatively uncommon complication related to the use of the femtosecond laser. Postoperative interface inflammation may increase the probability of developing TLSS, whereas an aggressive postoperative steroid regimen seemed to provide protection against it.
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Affiliation(s)
- Gonzalo Muñoz
- Refractive Surgery Department Centro de Especialidades Marqués de Sotelo and Hospital NISA Virgen del Consuelo, Valencia, Spain
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Nishio M, Arai K. Quantitative analysis of chondroitin sulfate in tear fluids following laser in situ keratomileusis. Ophthalmic Res 2006; 38:274-9. [PMID: 16974128 DOI: 10.1159/000095770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Accepted: 04/08/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To report chondroitin sulfate (CS) concentrations in tear fluid following laser in situ keratomileusis (LASIK). METHODS Fourteen eyes that underwent LASIK were enrolled. We measured the CS isomers chondroitin 4 sulfate and chondroitin 6 sulfate using an enzyme-linked immunosorbent assay preoperatively and postoperatively on days 1 and 4, week 1, and 1 and 3 months. RESULTS The chondroitin 4 sulfate concentration remained unchanged from preoperative values. The chondroitin 6 sulfate concentration increased temporarily 1 day postoperatively and gradually decreased thereafter. CONCLUSIONS CS in tear fluids participates in wound healing after LASIK. Clarifying its role in tear fluids will contribute to improved LASIK outcomes.
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Affiliation(s)
- Masaya Nishio
- Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
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Stonecipher KG, Dishler JG, Ignacio TS, Binder PS. Transient light sensitivity after femtosecond laser flap creation: Clinical findings and management. J Cataract Refract Surg 2006; 32:91-4. [PMID: 16516785 DOI: 10.1016/j.jcrs.2005.11.015] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 04/08/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the constellation of subjective and objective findings associated with unusual occurrences of photosensitivity after laser in situ keratomileusis (LASIK) with femtosecond flap creation and identify optimal management strategies. METHODS Demographic data, laser settings, subjective complaints, clinical findings, treatment, and response to treatment were recorded for suspected cases of transient postoperative photosensitivity from 3 surgeons operating at 3 different sites. All cases were estimated for the period covering the suspected cases at each site to assess incidence. Additional cases were solicited from IntraLase users via a survey. RESULTS For the 3 sites, 63 eyes from 33 patients were reported of a total estimated case log of 5667 (incidence, 1.1%). Average age was 41 years, and 51.7% of patients were women. Onset of symptoms ranged from 2 to 6 weeks after uneventful LASIK. All patients were treated with prednisolone acetate drops, whereas 1 surgeon also used Restasis (cyclosporine ophthalmic solution 0.05%). Patients noted improvement of symptoms within 1 week of treatment. When the raster and side-cut energy settings were lowered (by an average of 24% and 33%, respectively), significant reductions in incidence were noted. Similar findings were reported by 3 additional surgeons reporting 17 cases in the survey of IntraLase users. CONCLUSIONS This report describes a new complication of LASIK performed with a femtosecond laser keratome that may be related to the pulse energy used for flap creation. Although there is no loss of uncorrected visual acuity, symptoms can be prolonged, especially without prompt steroid therapy. Technical advances that reduced pulse energies appear to decrease the incidence.
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Affiliation(s)
- Karl G Stonecipher
- Southeastern Laser and Refractive Center, Greensboro, North Carolina, USA
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Laser literature watch. Photomed Laser Surg 2005; 23:233-42. [PMID: 15910194 DOI: 10.1089/pho.2005.23.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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