Molecular detection using aptamer-modified gold nanoparticles with an immobilized DNA brush for the prevention of non-specific aggregation

Gold nanoparticles (AuNPs) are often used for biosensing. In particular, aptamer-modified AuNPs are often used for colorimetric molecular detection, where target molecule-induced AuNP aggregates can be recognized by a color change from red to blue. However, non-specific aggregation could be induced by various compounds, leading to false-positive results. In this work we employed high-density ssDNA modification on the AuNP surface to prevent non-specific aggregation. The covalently immobilized DNA brush was used as an anchor for an aptamer specific for the target molecule. Herein, as a proof-of-concept study, we demonstrated detection of estradiol (E2), one of the endocrine-disrupting estrogen molecules as a model target, in the presence of antibiotic kanamycin (KN) as a model of co-contaminating compounds that induce non-specific aggregation of AuNPs. We also developed a smartphone dark field microscope (DFM) to visualize AuNP aggregation. Our previous study demonstrated that the observation of light scattering by AuNP aggregates with DFM can be applied for versatile molecular detection. In this work, we could successfully detect E2 with the smartphone DFM, and the results were verified by the results from a conventional benchtop DFM. This study would contribute to the future field applicability of AuNP-based sensors.

We demonstrated molecular detection using aptamer-modified gold nanoparticles with DNA-brush for the prevention of non-specific aggregation and smartphone darkfield microscopy.

Low molecular weight glycerol derived coatings on magnetic nanoparticles: role of initiator, temperature, rate of monomer addition, enhanced biocompatibility and stability

Biocompatible polymer coatings for magnetic nanoparticles have shown to drastically increase their usability towards biomedical applications. The coatings imprint characteristics such as stability, resistance to non-specific adsorption and tolerance in complex media for biomedicine. Herein, a thorough investigation towards the anionic ring-opening polymerization of glycidol on the surface of carbon-coated cobalt nanoparticle was performed. Reaction parameters that influence polymer growth have been investigated. Thereafter, a maximal achievable hyperbranched polyglycidol M_w of up to 1148 g mol⁻¹ under optimal reaction conditions was obtained. With this coating, the dispersion stability of the particles could be substantially increased, the non-specific adsorption of proteins could be decreased to 10% while retaining an efficient magnetic separation.

A highly efficient coating process of magnetic nanoparticles with hyperbranched polyglycidol was investigated and the resulting particles were tested towards their biocompatible capabilities.

Biochemical functionality of magnetic particles as nanosensors: how far away are we to implement them into clinical practice?

Magnetic nanosensors have become attractive instruments for the diagnosis and treatment of different diseases. They represent an efficient carrier system in drug delivery or in transporting contrast agents. For such purposes, magnetic nanosensors are used in vivo (intracorporeal application). To remove specific compounds from blood, magnetic nanosensors act as elimination system, which represents an extracorporeal approach. This review discusses principles, advantages and risks on recent advances in the field of magnetic nanosensors. First, synthesis methods for magnetic nanosensors and possibilities for enhancement of biocompatibility with different coating materials are addressed. Then, attention is devoted to clinical applications, in which nanosensors are or may be used as carrier- and elimination systems in the near future. Finally, risk considerations and possible effects of nanomaterials are discussed when working towards clinical applications with magnetic nanosensors.

Ultrasonic sensor concept to fit a ventricular assist device cannula evaluated using geometrically accurate heart phantoms

Future left ventricular assist devices (LVADs) are expected to respond to the physiologic need of patients; however, they still lack reliable pressure or volume sensors for feedback control. In the clinic, echocardiography systems are routinely used to measure left ventricular (LV) volume. Until now, echocardiography in this form was never integrated in LVADs due to its computational complexity. The aim of this study was to demonstrate the applicability of a simplified ultrasonic sensor to fit an LVAD cannula and to show the achievable accuracy in vitro. Our approach requires only two ultrasonic transducers because we estimated the LV volume with the LV end-diastolic diameter commonly used in clinical assessments. In order to optimize the accuracy, we assessed the optimal design parameters considering over 50 orientations of the two ultrasonic transducers. A test bench was equipped with five talcum-infused silicone heart phantoms, in which the intra-ventricular surface replicated papillary muscles and trabeculae carnae. The end-diastolic LV filling volumes of the five heart phantoms ranged from 180 to 480 mL. This reference volume was altered by ±40 mL with a syringe pump. Based on the calibrated measurements acquired by the two ultrasonic transducers, the LV volume was estimated well. However, the accuracies obtained are strongly dependent on the choice of the design parameters. Orientations toward the septum perform better, as they interfere less with the papillary muscles. The optimized design is valid for all hearts. Considering this, the Bland-Altman analysis reports the LV volume accuracy as a bias of ±10% and limits of agreement of 0%-40% in all but the smallest heart. The simplicity of traditional echocardiography systems was reduced by two orders of magnitude in technical complexity, while achieving a comparable accuracy to 2D echocardiography requiring a calibration of absolute volume only. Hence, our approach exploits the established benefits of echocardiography and makes them applicable as an LV volume sensor for LVADs.

Gene expression in human adipose-derived stem cells: comparison of 2D films, 3D electrospun meshes or co-cultured scaffolds with two-way paracrine effects

Finding the appropriate cues to trigger the desired differentiation is a challenge in tissue engineering when stem cells are involved. In this regard, three-dimensional environments are often compared to cells' two-dimensional culture behaviour (plastic culture dish). Here, we compared the gene expression pattern of human adipose-derived stem cells (ASC) seeded in a three-dimensional (3D) electrospun mesh and on a two-dimensional (2D) film - both of exactly the same material. Additionally, we conducted experiments with a scaffold floating above a film to investigate two-way paracrine effects (co-system). Electrospun meshes (3D scaffolds) and films (2D), consisting either of pristine poly-lactic-co-glycolic acid (PLGA) or of PLGA-containing dispersed amorphous calcium phosphate nanoparticles (PLGA/aCaP), were seeded with ASCs and cultured either in Dulbecco Minimum Essential Medium (DMEM) or in osteogenic medium. After two weeks, minimum stem cell criteria markers as well as typical markers for osteogenesis, endothelial cell differentiation, adipogenesis and chondrogenesis were analysed by quantitative real-time PCR. Interestingly, mostly osteogenic genes of cells seeded on 3D meshes were upregulated compared to those on 2D films, while stem cell markers seemed to be only slightly affected. Runx2 and osteocalcin showed an especially strong upregulation under all conditions, while most other factors analysed for 2D/3D changes were highly dependent on the material composition, the culture medium and on paracrine signalling effects. The beneficial 3D environment for stem cells found in many studies has therefore not to be attributed to the third dimension alone and should carefully be compared to 2D films fabricated of the same material. Furthermore, paracrine interactions triggering differentiation are not negligible.

Clinical outcomes of gamma-irradiated sterile cornea in aqueous drainage device surgery: a multicenter retrospective study

PurposeThe purpose of the study was to evaluate the safety and efficacy of gamma-irradiated sterile cornea (GISC) for covering the tube in aqueous drainage device (ADD) surgery in a retrospective, multicenter case series.Patients and methodsParticipants included 297 patients (321 procedures) who had undergone ADD surgery for the first time using GISC patch at three clinic centers in the United States between April 2009 and July 2012. The medical records of those consecutive patients were reviewed. Preoperative, intraoperative, and postoperative parameters about GISC were collected and analyzed. The main outcome measures were patch graft failure (PGF) and postoperative complications related to GISC.ResultsThree hundred and nineteen eyes in 295 patients were included in the current analysis. Ten out of the 319 eyes experienced PGF with a mean follow-up of 15.4±9.8 (SD) months. The overall cumulative PGF proportion from Kaplan-Meier analysis was 2.6% (95% CI: 0.6-4.7%) at 18 months. We detected two cases of presumed endophthalmitis related to PGF.ConclusionsGISC appears to have a reasonable success rate for preventing tube exposure related to PGF over an 18-month period. This success rate, in combination with other features of GISC (transparency and storage at room temperature), makes it a viable choice for patch graft material during ADD.

Magnetic separation-based blood purification: a promising new approach for the removal of disease-causing compounds?

Recent studies report promising results regarding extracorporeal magnetic separation-based blood purification for the rapid and selective removal of disease-causing compounds from whole blood. High molecular weight compounds, bacteria and cells can be eliminated from blood within minutes, hence offering novel treatment strategies for the management of intoxications and blood stream infections. However, risks associated with incomplete particle separation and the biological consequences of particles entering circulation remain largely unclear. This article discusses the promising future of magnetic separation-based purification while keeping important safety considerations in mind.

Insight into the beneficial immunomodulatory mechanism of the sevoflurane metabolite hexafluoro-2-propanol in a rat model of endotoxaemia

Volatile anaesthetics such as sevoflurane attenuate inflammatory processes, thereby impacting patient outcome significantly. Their inhalative administration is, however, strictly limited to controlled environments such as operating theatres, and thus an intravenously injectable immunomodulatory drug would offer distinct advantages. As protective effects of volatile anaesthetics have been associated with the presence of trifluorinated carbon groups in their basic structure, in this study we investigated the water-soluble sevoflurane metabolite hexafluoro-2-propanol (HFIP) as a potential immunomodulatory drug in a rat model of endotoxic shock. Male Wistar rats were subjected to intravenous lipopolysaccharide (LPS) and thereafter were treated with HFIP. Plasma and tissue inflammatory mediators, neutrophil invasion, tissue damage and haemodynamic stability were the dedicated end-points. In an endotoxin-induced endothelial cell injury model, underlying mechanisms were elucidated using gene expression and gene reporter analyses. HFIP reduced the systemic inflammatory response significantly and decreased endotoxin-induced tissue damage. Additionally, the LPS-provoked drop in blood pressure of animals was resolved by HFIP treatment. Pathway analysis revealed that the observed attenuation of the inflammatory process was associated with reduced nuclear factor kappa B (NF-κΒ) activation and suppression of its dependent transcripts. Taken together, intravenous administration of HFIP exerts promising immunomodulatory effects in endotoxaemic rats. The possibility of intravenous administration would overcome limitations of volatile anaesthetics, and thus HFIP might therefore represent an interesting future drug candidate for states of severe inflammation.

Management of epithelial ingrowth and cysts

In 12 consecutive cases of epithelial ingrowth operated on during the past 50 months, therapy included photocoagulation on the iris followed by excision of involved iris tissue and vitreous gel by means of instruments designed for vitreous surgery. Epithelium remaining on the posterior surface of the cornea, the ciliary body, and in the anterior chamber was destroyed by controlled transcorneal and transscleral cryotherapy. An intraocular air bubble was used to provide an insulating effect and a more effective, controllable freeze. All patients except two had improved vision postoperatively, and 3 of the 12 patients has postoperative visual acuity of 6/12 (20/40) or better. Similar closed-eye cryodestructive techniques have been used for treatment of enlarging epithelial cysts.

Surgical management of persistent hyperplastic primary vitreous

Instruments designed for pars plana vitrectomy can be used to manage complicated congenital cataracts such as those with persistent hyperplastic primary vitreous (PHPV). We have applied closed-eye vitrectomy techniques through a limbal approach in seven eyes with PHPV. A clear pupillary space was achieved in all cases. The management of children with complicated congenital cataracts such as PHPV is discussed.

Current concepts in intraocular lens implantation

PC IOLs appear to be safe and effective and there are few contraindications. Based on the available data we feel confident about implanting PC IOLs in healthy eyes of patients aged 40 or older. For younger patients, we do not recommended an IOL unless glasses or contact lens use is not feasible. Caution is urged however in the use of semiflexible, closed-loop AC IOLs as well as 'soft' PC IOLs. Other questions regarding material of choice, bag versus sulcus fixation, and UV absorbers remain controversial.

β-D-glucosidase assisted gold dissolution as non-optical and quantifiable detection technique for immunoassays

Immunoassays are used for detecting protein targets for various applications. Here, a modification of immunoassays to allow a purely electrical detection of the target protein concentration is shown. The modification comprises a β-D-glucosidase as reporter enzyme and a cyanogenic glycoside as substrate. The enzymatic reaction produces cyanide in small quantities. For electrical detection of the cyanide, a novel sensor is developed, based on a gold micro wire. The cyanide dissolves the gold wire and changes the electrical resistance of the wire. Monitoring the resistance change allows a quantitative measurement of the target human C-reactive protein (an inflammatory marker) in blood plasma in the physiological relevant concentration range.

Combining phosphate and bacteria removal on chemically active filter membranes allows prolonged storage of drinking water

A chemically active filtration membrane with incorporated lanthanum oxide nanoparticles enables the removal of bacteria and phosphate at the same time and thus provides a simple device for preparation of drinking water and subsequent safe storage without using any kind of disinfectants.

Thermoresponsive polymer induced sweating surfaces as an efficient way to passively cool buildings

Buildings can be effectively cooled by a bioinspired sweating-like action based on thermoresponsive hydrogels (PNIPAM), which press out their stored water when exceeding the lower critical solution temperature. The surface temperature is reduced by 15 °C compared to that of a conventional hydrogel (pHEMA) and by 25 °C compared to the bare ground.

One-step large scale gas phase synthesis of Mn(2 + ) doped ZnS nanoparticles in reducing flames

Metal sulfide nanoparticles have attracted considerable interest because of their unique semiconducting and electronic properties. In order to prepare these fascinating materials at an industrial scale, however, solvent-free, dry processes would be most advantageous. In the present work, we demonstrate how traditional oxide nanoparticle synthesis in flames can be extended to sulfides if we apply a careful control on flame gas composition and sulfur content. The ultra-fast (<1 ms) gas phase kinetics at elevated temperatures allow direct sulfidization of metals in flames ([Formula: see text]). As a representative example, we prepared air-stable Mn(2 + ) doped zinc sulfide nanoparticles. Post-sintering of the initially polycrystalline nanopowder resulted in a material of high crystallinity and improved photoluminescence. An analysis of the thermodynamics, gas composition, and kinetics in these reducing flames indicates that the here-presented extension of flame synthesis provides access to a broad range of metal sulfide nanoparticles and offers an alternative to non-oxide phosphor preparation.

Magnetic switching of optical reflectivity in nanomagnet/micromirror suspensions: colloid displays as a potential alternative to liquid crystal displays

Two-particle colloids containing nanomagnets and microscale mirrors can be prepared from iron oxide nanoparticles, microscale metal flakes and high-density liquids stabilizing the mirror suspension against sedimentation by matching the constituent's density. The free Brownian rotation of the micromirrors can be magnetically controlled through an anisotropic change in impulse transport arising from impacts of the magnetic nanoparticles onto the anisotropic flakes. The resulting rapid mirror orientation allows large changes in light transmission and switchable optical reflectivity. The preparation of a passive display was conceptually demonstrated through colloid confinement in a planar cavity over an array of individually addressable solenoids and resulted in 4 x 4 digit displays with a reaction time of less than 100 ms.

Fine-tuning of bioactive glass for root canal disinfection

An ideal preparation of 45S5 bioactive glass suspensions/slurries for root canal disinfection should combine high pH induction with capacity for continuing release of alkaline species. The hypothesis of this study was that more material per volume of bioactive glass slurry is obtained with a micrometric material (< 5 microm particle size) or a micrometric/ nanometric hybrid, rather than a solely nanometric counterpart. This should correlate with alkaline capacity and antimicrobial effectiveness. Slurries at the plastic limit were prepared with test and reference materials in physiological saline. Total mass and specific surface area of glass material per volume were determined. Continuous titration with hydrochloric acid was performed, and antimicrobial effectiveness was tested in extracted human premolars mono-infected with E. faecalis ATTC 29212 (N = 12 per material). While the nanometric slurry had a 12-fold higher specific surface area than the micrometric counterpart, the latter had a considerably higher alkaline capacity and disinfected significantly better (Fisher's exact test, P < 0.05). The hybrid slurry behaved similarly to the micrometric preparation.

Crosslinking metal nanoparticles into the polymer backbone of hydrogels enables preparation of soft, magnetic field-driven actuators with muscle-like flexibility

The combination of force and flexibility is at the core of biomechanics and enables virtually all body movements in living organisms. In sharp contrast, presently used machines are based on rigid, linear (cylinders) or circular (rotator in an electrical engine) geometries. As a potential bioinspired alternative, magnetic elastomers can be realized through dispersion of micro- or nanoparticles in polymer matrices and have attracted significant interest as soft actuators in artificial organs, implants, and devices for controlled drug delivery. At present, magnetic particle loss and limited actuator strength have restricted the use of such materials to niche applications. We describe the direct incorporation of metal nanoparticles into the backbone of a hydrogel and application as an ultra-flexible, yet strong magnetic actuator. Covalent bonding of the particles prevents metal loss or leaching. Since metals have a far higher saturation magnetization and higher density than oxides, the resulting increased force/volume ratio afforded significantly stronger magnetic actuators with high mechanical stability, elasticity, and shape memory effect.

Advanced piezoresistance of extended metal-insulator core-shell nanoparticle assemblies

Assembled metal-insulator nanoparticles with a core-shell geometry provide access to materials containing a large number (>10(6)) of tunneling barriers. We demonstrate the production of ceramic coated metal nanoparticles exhibiting an exceptional pressure-sensitive conductivity. We further show that graphene bi- and trilayers on 20 nm copper nanoparticles are insulating in such a core-shell geometry and show a similar pressure-dependent conductivity. This demonstrates that core-shell metal-insulator assemblies offer a route to alternative sensing materials.

Do bioactive glasses convey a disinfecting mechanism beyond a mere increase in pH?

AIM

To test whether bioactive glasses kill microbiota via mineralization or the release of ions other than sodium.

METHODOLOGY

Flame-spray synthesis was applied to produce nanometric glasses of different sodium content and constant Ca/P ratio: 28S5, 45S5 and 77S. Calcium hydroxide and nanometric tricalcium phosphate (TCP) were used as controls. Apatite induction was monitored by Raman spectroscopy. Bovine dentine disks with adherent Enterococcus faecalis cells were exposed to test and control suspensions or buffered solutions for 1 h, 1 day and 1 week. Colony-forming units were counted and disks were inspected using scanning electron microscopy. Suspension supernatants and solutions were analysed for their pH, osmolarity, calcium and silicon content.

RESULTS

Sodium containing glasses induced pH levels above 12, compared with less than pH 9 with sodium-free 77S. Calcium hydroxide, 45S5 and 28S5 killed all bacteria after 1 day and lysed them after 1 week. TCP caused the highest apatite induction and substantial calcification on bacteria adhering to dentine, but did not reduce viable counts. 77S achieved disinfection after 1 week without visible apatite formation, whilst the buffer solution at pH 9 caused only minimal reduction in counts.

CONCLUSION

Bioactive glasses have a directly and an indirectly pH-related antibacterial effect. The effect not directly linked to pH is because of ion release rather than mineralization.

Preparation of an ultra fast binding cement from calcium silicate-based mixed oxide nanoparticles

Building construction takes time, in part because the binding process of cement is based on the slow re-crystallization and precipitation of calcium silicate species. Since the material's reactivity is surface area limited, a reduction in particle size of Portland cements has been used to prepare faster binding formulations. The present work investigates a new and direct, one-step preparation of calcium silicate-based nanoparticles of a typical Portland cement composition by flame spray synthesis. Isothermal calorimetry revealed that the hardening of this new nano-cement corroborated a more than tenfold increase of initial reactivity with different reaction kinetics if compared to conventionally prepared cements. At present, the unfavourably high porosity of nano-cements, however, underlines the need for additional improvements of chemical composition and formulation to make these highly reactive materials applicable to modern construction work, where load-bearing strength is of importance.

Effect of sodium hypochlorite on human root dentine – mechanical, chemical and structural evaluation

AIM

To investigate the mechanical, chemical and structural alterations of human root dentine following exposure to ascending sodium hypochlorite concentrations.

METHODOLOGY

Three-point bending tests were carried out on standardized root dentine bars (n = 8 per group, sectioned from sound extracted human third molar teeth) to evaluate their flexural strength and modulus of elasticity after immersion in 5 mL of water (control), 1% NaOCl, 5% NaOCl or 9% NaOCl at 37 degrees C for 1 h. Additional dentine specimens were studied using microelemental analysis, light microscopy following bulk staining with basic fuchsin, and scanning electron microscopy (SEM). Numerical data were compared using one-way ANOVA. Bonferroni's correction was applied for multiple testing.

RESULTS

Immersion in 1% NaOCl did not cause a significant drop in elastic modulus or flexural strength values in comparison to water, whilst immersion in 5% and 9% hypochlorite reduced these values by half (P < 0.05). Both, carbon and nitrogen contents of the specimens were significantly (P < 0.05) reduced by 5% and 9% NaOCl, whilst 1% NaOCl had no such effect. Exposure to 5% NaOCl rendered the superficial 80-100 mum of the intertubular dentine permeable to basic fuchsin. Three-dimensional SEM reconstructions of partly demineralized specimens showed NaOCl concentration-dependent matrix deterioration. Backscattered electron micrographs revealed that hypochlorite at any of the tested concentrations left the inorganic dentine components intact.

CONCLUSIONS

The current data link the concentration-dependent hypochlorite effect on the mechanical dentine properties with the dissolution of organic dentine components.

Antimicrobial effect of nanometric bioactive glass 45S5

Most recent advances in nanomaterials fabrication have given access to complex materials such as SiO(2)-Na(2)O-CaO-P(2)O(5) bioactive glasses in the form of amorphous nanoparticles of 20- to 60-nm size. The clinically interesting antimicrobial properties of commercially available, micron-sized bioactive glass 45S5 have been attributed to the continuous liberation of alkaline species during application. Here, we tested the hypothesis that, based on its more than ten-fold higher specific surface area, nanometric bioactive glass releases more alkaline species, and consequently displays a stronger antimicrobial effect, than the currently applied micron-sized material. Ionic dissolution profiles were monitored in simulated body fluid. Antimicrobial efficacy was assessed against clinical isolates of enterococci from persisting root canal infections. The shift from micron- to nano-sized treatment materials afforded a ten-fold increase in silica release and solution pH elevation by more than three units. Furthermore, the killing efficacy was substantially higher with the new material against all tested strains.

Grain growth resistance and increased hardness of bulk nanocrystalline fcc cobalt prepared by a bottom-up approach

Bulk nanocrystalline cobalt was prepared from reducing flame-spray-derived cobalt nanopowders exclusively in the face-centred cubic (fcc) modification. Compacts of approximately 60% density were obtained from uniaxial compression at room temperature and showed a strong resistance towards grain growth upon subsequent sintering to 90% relative density. The nanocrystalline structure remained stable well above 1000 degrees C and resulted in a pore-rich metal with about 10(15) nanovoids cm(-3). These sintered compacts displayed an up to three times higher bulk hardness if compared to conventional cobalt and local ductility as evidenced from scanning electron microscopy and nanoindentation. The strong grain-growth resistance and consequent increase in material hardness are discussed in respect of the presence of nanovoids, twin boundaries and material contamination.

Large-scale production of carbon-coated copper nanoparticles for sensor applications

Copper nanoparticles with a mean carbon coating of about 1 nm were continuously produced at up to 10 g h(-1) using a modified flame spray synthesis unit under highly reducing conditions. Raman spectroscopy and solid state (13)C magic angle spinning nuclear magnetic resonance spectroscopy revealed that the thin carbon layer consisted of a sp(2)-hybridized carbon modification in the form of graphene stacks. The carbon layer protected the copper nanoparticles from oxidation in air. Bulk pills of pressed carbon/copper nanoparticles displayed a highly pressure- and temperature-dependent electrical conductivity with sensitivity at least comparable to commercial materials. These properties suggest the use of thin carbon/copper nanocomposites as novel, low-cost sensor materials and offer a metal-based alternative to the currently used brittle oxidic spinels or perovskites.

The safety and efficacy of combined phacoemulsification and trabeculectomy with releasable sutures

AIM

To evaluate the combined phacoemulsification with acrylic intraocular lens implantation and trabeculectomy with releasable sutures, without the use of antimetabolites, performed by one surgeon.

METHODS

A retrospective analysis was performed on 251 eyes of 198 patients after a combined phaco/trabeculectomy procedure, followed up for an average of 16 months for vision, intraocular pressure (IOP), and number of glaucoma medications. Cox proportional hazard regression analysis provided measures of relative risk (RR) or hazards ratios and 95% confidence intervals (CIs) associated with the occurrence of several conditions or complications of surgery.

RESULTS

Mean preoperative variables were best corrected vision, 0.6 (SD 0.4) logMAR (20/80 Snellen); IOP, 18.7 (4.9) mm Hg; and number of glaucoma medications, 1.7 (0.8). Mean postoperative results were best corrected vision, 0.2 (0.4) logMAR (20/32 Snellen); IOP, 15.1 (3.2) mm Hg; and number of glaucoma medications, 0.3 (0.6). Postoperatively, the mean decreases from baseline were 19.2% for IOP and 84.1% for number of glaucoma medications; 85% of eyes required fewer glaucoma medications and 78% of eyes were medication free, with IOP control. There were no significant operative or postoperative complications.

CONCLUSION

Combined phacoemulsification and trabeculectomy with releasable sutures, in the absence of antimetabolites, is a safe, effective, and stable alternative for patients with cataracts and glaucoma.

A new donor cornea harvesting technique for posterior lamellar keratoplasty

AIMS

To describe a technique for posterior lamellar keratoplasty donor preparation.

METHODS

In an experimental study eight human donor research corneas were mounted onto an artificial anterior chamber and deep stromal pockets dissected. Four corneas were mounted in the standard endothelial side down orientation and dissected using standard instruments (group 1). Another four corneas were mounted endothelial side up and dissected using a flat spatula (group 2). Trephined lamellar graft thickness was assessed by ultrasound pachymetry. The grafts were also analysed using vital staining of the endothelium and standard histological preparation.

RESULTS

Achieved posterior graft thickness was 118 (SD 32) microm (group 1) and 92 (23) microm (group 2) (p=0.324). Percentage of devitalised endothelial cells was 0.86% (1.48%) (group 1) and 3.9% (2.9%) (group 2) (p=0.185). The dissections using both harvesting techniques remained in plane and were smooth.

CONCLUSIONS

A blunt spatula and endothelium side up orientation on an artificial anterior chamber can be used to create posterior lamellar dissections without compromising endothelial cell number or planarity when compared to standard endothelium side down harvest.

Microarray analysis of gene expression in human donor corneas

OBJECTIVES

To use microarray analysis to identify genes expressed in human donor corneas and to create a preliminary, comprehensive database of human corneal gene expression.

METHODS

A complementary DNA (cDNA) library was constructed from transplant-quality, human donor corneas. Biotin-labeled RNA was transcribed from the cDNA library and hybridized in duplicate to microarrays containing approximately 5600 human genes. Results were analyzed using a gene database of the National Institutes of Health, Bethesda, Md. Reverse transcriptase polymerase chain reaction analysis was performed to confirm corneal expression of genes identified by microarray analysis.

RESULTS

Duplicate microarrays identified the expression of 1200 genes in human donor corneas. Chromosomal loci had been assigned to 1025 (85%) of these genes. A preliminary database of human corneal gene expression was compiled. A Web site containing these genes was created. Six collagen genes were identified that had not previously been localized within the cornea. Five apoptosis-related genes were identified, 4 of which had not previously been localized within the cornea. Three genes previously shown to cause corneal diseases were identified. Reverse transcriptase polymerase chain reaction analysis of genes identified by microarray analysis confirmed the corneal expression of 2 apoptosis-related genes and 1 collagen gene.

CONCLUSIONS

Microarray analysis of healthy human donor corneas has produced a preliminary, comprehensive database of corneal gene expression. Large-scale analysis of gene expression has the potential to generate large amounts of data, which should be made readily accessible to the scientific community. The Internet offers many potential advantages as a medium for the maintenance of these large data sets.

CLINICAL RELEVANCE

Identification of structural, apoptosis-related, and disease-causing genes within the cornea by microarrays may increase the understanding of normal and abnormal corneal function with likely relevance to corneal diseases and transplants.

The role of apoptosis in the pathogenesis of Fuchs endothelial dystrophy of the cornea

OBJECTIVE

To investigate the potential role of apoptosis in the pathogenesis of Fuchs endothelial dystrophy of the cornea.

METHODS

Twenty-one corneal buttons from patients with Fuchs dystrophy and 15 control corneas were studied. Apoptosis was assessed by the in situ end-labeling of double-stranded DNA breaks, and by immunohistochemical characterization of cellular markers associated with apoptosis (Fas, FasL, Bcl-2, and Bax). Expression of Bcl-2 and Bax mRNA in the corneal stroma and endothelium was separately analyzed by a semiquantitative reverse transcriptase polymerase chain reaction. Furthermore, cultivated keratocytes generated from diseased corneal buttons and donor rims were exposed to camptothecin, an apoptotic inducer, for 6 and 24 hours. They were then examined for protein and messenger RNA (mRNA) expression of apoptotic regulatory molecules.

RESULTS

DNA fragmentation was seen in the epithelium, stroma, and endothelium in 6 of 7 corneas with Fuchs dystrophy. A statistically significant difference was identified in the expression of Bax and its mRNA in the stroma, but not in the endothelium of Fuchs dystrophy corneas. Following exposure to camptothecin, keratocytes from patients with Fuchs dystrophy responded with an increased level of Bax and a low level of Bcl-2. This trend was distinctively different from the response of normal keratocytes.

CONCLUSIONS

The evidence in this study points to a disease-related disturbance in the regulation of apoptosis in Fuchs dystrophy. Our findings suggest that excessive apoptosis may be an important mechanism in the pathogenesis of Fuchs dystrophy.

Spontaneous corneal perforation in a patient with unusual unilateral pellucid marginal degeneration

A 56-year-old man presented with acute loss of vision and tearing in his left eye. Slitlamp examination demonstrated peripheral corneal edema extending between the 2 and 6 o'clock positions as well as a perforation located inferiorly. The right eye was unremarkable. An emergent crescentic lamellar keratoplasty was performed. The patch graft remained clear during the 30-month follow-up, and visual acuity improved significantly. No changes occurred in the right eye. This case represents an unusual, unilateral corneal ectatic disorder, most likely pellucid marginal degeneration.

Cataract surgery by phacoemulsification in adults with retinopathy of prematurity

PURPOSE

To report the preoperative, operative, and postoperative factors associated with phacoemulsification cataract surgery in adults with retinopathy of prematurity.

METHODS

Records of patients with retinopathy of prematurity who underwent phacoemulsification at The Wilmer Institute between January 1990 and January 2000 were retrospectively searched. Seventeen adults (9 women, 8 men) with retinopathy of prematurity were identified who had undergone phacoemulsification for visually significant cataract or phacomorphic glaucoma and who had at least 6 months of postoperative follow-up.

RESULTS

Cataract extraction by phacoemulsification was performed on 20 eyes. Follow-up ranged from 6 to 103 months (mean, 32 months). A posterior chamber intraocular lens was placed in 18 eyes; two eyes were left aphakic for refractive reasons. Zonular weakness was noted in two eyes in which the intraocular lens was suture fixated to the sclera. Concomitant trabeculectomy was performed in one eye. Visual acuity improved in 18 of 20 eyes and remained unchanged in two eyes. Postoperatively, visual acuity was worse than 5/200 in two eyes, 5/200 to worse than 20/100 in five eyes, 20/100 to 20/50 in five eyes, and 20/40 or better in eight eyes. One eye developed a rhegmatogenous retinal detachment 1 month after cataract surgery; the retina was successfully reattached.

CONCLUSIONS

Although cataract extraction in eyes with regressed retinopathy of prematurity may present challenges, such as high myopia, monocularity, glaucoma, and previous ocular surgery, phacoemulsification in this series proved to be relatively safe as well as visually rehabilitating. The surgeon should be aware of the special considerations in this population, alert to potential zonular weakness intraoperatively, and careful of increased postoperative risks, including retinal detachment.

Management of flap striae

There have been no comprehensive investigations of striae after LASIK. The ophthalmic literature has few reports, and no one consistent therapy has been recommended. Striae are relatively uncommon; nevertheless, refractive surgeons need a systematic approach in prevention and therapy for striae. Careful flap handling and positioning can prevent many striae. Early recognition is very important and makes treatment significantly more likely to eliminate or reduce the striae. If the striae are identified within 24 hours, lifting and refloating will likely result in resolution of the striae. If the striae are more imbedded and have been present longer, additional techniques, such as those discussed, are helpful. New techniques will likely be developed because of an increase in lamellar procedures and an increase in the occurrence of striae.

The role of apoptosis in the early corneal wound healing after excimer laser keratectomy in the rat

BACKGROUND

The potential role of apoptosis in corneal wound healing after excimer laser keratectomy was investigated in a rat model.

METHODS

Lewis rats underwent laser keratectomy using a 193-nm excimer laser. The central corneas were ablated in three depths: group A, epithelium; group B, superficial stroma; group C, deep stroma. Eyes were collected at 1, 12, 24, and 36 h and 1 week. Cellular markers associated with apoptosis--Fas, Fas ligand (FasL), Bcl-2, and Bax were examined by immunohistochemistry. Keratocyte depletion and endothelial changes were evaluated histologically. In situ end labeling of double-stranded DNA breaks was used to demonstrate apoptosis in corneal sections.

RESULTS

Keratocyte depletion was observed in 6 (50%) of 12 rats (total from groups A, B, and C) at 12 h, 11 (73%) of 15 at 24 h, 3 (20%) of 15 at 36 h, and 2 (15%) of 13 at 1 week after laser surgery. Corneal endothelial edema was observed in the ablation zone. Expression of Fas, FasL, Bcl-2, and Bax in corneal cells showed dynamics similar to that of keratocyte depletion and endothelial changes. There was less expression of apoptotic molecules in newly generated epithelial cells and more in endothelial cells of the stromal ablation groups.

CONCLUSIONS

Excimer laser keratectomy triggered apoptosis of corneal keratocytes and endothelial cells. More endothelial edema was observed in the stromal ablation than in the epithelial ablation group. The expression of apoptotic molecules coincided with the period of keratocyte depletion and regeneration and of endothelial recovery, suggesting that apoptosis is a dynamic part of corneal wound healing and remodeling after excimer laser keratectomy.

Surgical management of recurrent iris stromal cyst

PURPOSE

To report the clinical history and surgical management of recurrent congenital iris stromal cyst.

METHOD

Case report. Argon laser endophotocoagulation and cryotherapy were used to treat a recurrent iris stromal cyst in an 18-month-old boy.

RESULTS

At 43 months of follow-up, there was no recurrence or evidence of epithelial ingrowth.

CONCLUSION

Treatment with argon laser endophotocoagulation and cryotherapy resulted in complete resolution of a recurrent congenital iris cyst.

Herpes simplex virus DNA identification from aqueous fluid in Fuchs heterochromic iridocyclitis

PURPOSE

To report the presence of herpes simplex virus DNA in the aqueous humor of an eye with Fuchs heterochromic iridocyclitis.

METHODS

In an eye with a clinical diagnosis of Fuchs heterochromic iridocyclitis, samples of aqueous humor and anterior capsule of the lens were obtained during cataract surgery. Polymerase chain reaction was performed on the samples to detect the presence of viral DNA including herpes simplex virus, varicella-zoster virus, and cytomegalovirus. Serologic analysis was also performed for antiviral immunoglobulins.

RESULTS

Herpes simplex virus DNA was identified in the aqueous humor but not in the anterior capsule. Serum immunoglobulin G was positive for herpes simplex virus, varicella-zoster virus, and cytomegalovirus.

CONCLUSIONS

The presence of herpes simplex virus DNA in the aqueous humor of an eye with Fuchs heterochromic iridocyclitis suggests that herpes simplex virus infection may play a role in the pathogenesis of Fuchs heterochromic iridocyclitis.

Phototherapeutic keratectomy for superficial corneal fibrosis after radial keratotomy

We report on 4 patients who developed superficial corneal fibrosis after radial keratotomy. All 4 were treated successfully with manual debridement of the epithelium and manual excision of the fibrous scar, followed by phototherapeutic keratectomy.

Cytokine-induced calgranulin C expression in keratocytes

The authors have identified a corneal stromal protein (CO-Ag) that may be involved in the pathogenesis of Mooren's ulcer. The CO-Ag cDNA sequence is identical to that of human neutrophil calgranulin C (CaGC). This study sought to demonstrate expression of the CaGC gene in the human cornea and in corneal keratocytes after cytokine stimulation. In situ hybridization and immunohistochemistry were used to localize CaGC mRNA and protein in normal and diseased human corneas, including a specimen with Mooren's ulcer. Cultured bovine keratocytes were stimulated with IL-1 alpha or TNF-alpha, and reverse transcription polymerase chain reaction (RT-PCR) was performed to amplify CaGC cDNA from cytokine-stimulated keratocytes and unstimulated controls. Southern blotting verified the specificity of the RT-PCR amplification products. In situ hybridization detected human CaGC mRNA in the stroma of corneas with Fuchs' dystrophy, postinfection corneas, and a cornea with Mooren's ulcer. In cultured bovine keratocytes, peak levels of CaGC mRNA were reached 6 h after cytokine stimulation. Southern blots with an oligonucleotide probe specific for CaGC detected the RT-PCR products of expected sizes (273 bp) and confirmed that the amplified CO-Ag sequence was identical to that of CaGC. These studies are the first to demonstrate the presence of CaGC in the human cornea and the ability of stromal keratocytes to produce CaGC (CO-Ag). The up-regulation of CaGC gene expression by corneal keratocytes due to proinflammatory cytokines from trauma or inflammation may induce autoimmunity that ultimately results in Mooren's ulceration.

Inflammatory response in the early stages of wound healing after excimer laser keratectomy

OBJECTIVE

To evaluate the inflammatory response and its potential role in the early stages of corneal wound healing after excimer laser keratectomy.

MATERIALS AND METHODS

Lewis rats underwent excimer keratectomy using a 193-nm excimer laser. The central corneas were ablated in 3 depths: group A, epithelium; group B, superficial stroma; or group C, deep stroma. Eyes were harvested 1, 12, 24, and 36 hours, and 1 week after the rats were killed. Immunohistochemistry was used to test frozen sections with monoclonal antibodies of various inflammatory cellular markers.

RESULTS

Reepithelialization was observed at 12 hours in group A, and at 24 hours in groups B and C. Regenerated epithelium covered the denuded corneal surface in groups B and C after 1 week. The expression of major histocompatibility complex II antigen was detected in infiltrating cells, corneal epithelial cells, and endothelial cells 1 hour after surgery. Only a few macrophages and Langerhans cells were in the limbus at baseline. Macrophages migrated from the limbus to the corneal ablation zone and increased 2-fold after 36 hours in all 3 groups compared with baseline. Occasional lymphocytic infiltration was identified after 25 to 36 hours.

CONCLUSION

Macrophages play an active role in the wound healing after laser keratectomy and may contribute to transient corneal haze.

Defensin gene expression in the cornea

PURPOSE

To determine whether defensin genes are expressed in human corneas and bovine corneal keratocytes.

METHODS

In situ hybridization and immunohistochemistry were used to localize defensin mRNA and protein in normal and diseased human corneas. Cultured bovine keratocytes were stimulated with IL-1alpha or TNFalpha to determine whether defensin mRNA production occurred. Reverse transcription polymerase chain reaction (RT-PCR) was performed to amplify defensin cDNA from cytokine-induced keratocytes, and Southern blots were used to verify the specificity of RT-PCR amplification products.

RESULTS

Defensin mRNA and protein were not detected in normal human corneal stroma, but were readily detectable in the corneal stroma in cases of rejected transplants and postinfectious keratitis. IL-1alpha was a potent inducer of defensin gene expression in keratocytes, which began 12 h after challenge and peaked at 18 to 24 h. TNFalpha weakly induced defensin mRNA in keratocytes at about 18 h. Southern blots of the RT-PCR products probed with an oligonucleotide complementary to internal sequences of defensin demonstrated the appropriately sized products (198 bp) specific for defensin.

CONCLUSIONS

This report demonstrates the presence of defensin in the human cornea and the capacity of corneal keratocytes to produce defensin mRNA in response to IL-1alpha and TNFalpha. Release of defensins by keratocytes in response to cytokines elaborated in corneal inflammation may contribute to the host defense response in microbial keratitis.

Cataracts. Lifting the clouds on an age-old problem

Cataracts are the most common treatable form of reduced vision in older adults. Although the incidence of cataracts is high after age 65, careful history taking and clinical examination are essential to establish the diagnosis. Cataract surgery is medically indicated when the view to the retina is obscured or lens-induced disorders place the eye at risk for further damage. However, even when patients have no specific associated medical problem, other than decreased visual acuity, cataract extraction offers an important means for maintaining independence and improving quality of life.

Refractive and keratometric results after the triple procedure: experience with early and late suture removal

OBJECTIVE

The objective of this study was to determine the outcome of early and late suture removal after the triple procedure (i.e., penetrating keratoplasty, cataract extraction, lens implant).

DESIGN AND PARTICIPANTS

The refractive and keratometric results of 106 eyes undergoing the triple procedure were reviewed. The target postoperative refractive error was -1 diopter (D).

RESULTS

Average length of follow-up was 40.3 months. Twenty eyes had sutures removed early (<18 months after surgery), 39 had sutures removed late (> or = 18 months after surgery), and 47 had sutures still intact at last follow-up. A best spectacle-corrected visual acuity of 20/40 or better was achieved in 90% of eyes with sutures removed early, 82.1% with sutures removed late, and 70.2% with sutures in place. For all eyes, the mean spherical equivalent at last follow-up was -2.50 D, with 75% of eyes falling between -4 and +2 D. The mean final refractive error was -3.40 +/- 3.53 D for eyes with sutures removed early and -1.79 +/- 3.99 D for eyes with sutures removed late. Eyes with sutures remaining had a mean final refractive error of -0.33 +/- 2.25 D. There was an overall decrease in refractive and keratometric astigmatism after both early and late suture removal with no significant difference between groups. However, there was a wide range of change with some eyes experiencing a decrease and others an increase in astigmatism. Mean postoperative K readings increased significantly for both groups after suture removal (final mean K, 47.00 D) but remained stable for eyes with sutures in.

CONCLUSION

The authors data suggest that the final refractive error and net change in refractive and keratometric astigmatism after the triple procedure are not dependent on the timing of suture removal.

Prospective, randomized vector analysis of astigmatism after three-, one-, and no-suture phacoemulsification

PURPOSE

To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification.

SETTING

Johns Hopkins Hospital, Baltimore, Maryland and Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.

METHODS

This prospective, randomized study followed 131 patients treated with phacoemulsification with a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon sutures were used in the three- and one-suture groups.

RESULTS

Mean astigmatism was greatest in the first postoperative week in all groups and stabilized after 8 weeks. The percentage of patients with with-the-rule (WTR) astigmatism increased from baseline in the one- and three-suture groups and decreased in the sutureless group. Mean uncorrected Snellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant differences in uncorrected acuity at other times. No statistically significant differences in the surgically induced spherical equivalent were noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively. At all follow-ups, the sutureless group had the greatest proportion of patients, with significant ATR astigmatic shift (1 week, 17%; 4 weeks, 32%); and the lowest proportion of patients with significant WTR astigmatic shift (10% after 1 week). At 4 weeks, the percentage of patients with significant WTR shift in the one-suture group dropped to that in the sutureless group (10%); however, those in the one-suture group had less ATR astigmatic shift (16%).

CONCLUSION

Sutureless and one-suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-suture surgery resulted in less ATR shift.