1. Cornea. 2015 Nov 17. [Epub ahead of print]

Deep Anterior Lamellar Keratoplasty Versus Penetrating Keratoplasty: A
Meta-Analysis of Randomized Controlled Trials.

Chen G(1), Tzekov R, Li W, Jiang F, Mao S, Tong Y.

Author information: 
(1)*Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang,
China; †The Roskamp Institute, Sarasota, FL; ‡Department of Ophthalmology,
University of South Florida, Tampa, FL; and §Xiamen Eye Center of Xiamen
University, Xiamen, Fujian, China.

PURPOSE: To evaluate the efficacy and safety of deep anterior lamellar
keratoplasty (DALK) compared with penetrating keratoplasty (PK) for patients who 
had corneal stromal pathologies without endothelial abnormalities.
METHODS: We performed a meta-analysis using databases including PUBMED, EMBASE,
and ClinicalTrials.gov to find relevant randomized controlled trials. Efficacy
parameters were the postoperative best-corrected visual acuity, uncorrected
visual acuity, and refractive error. Safety parameters were postoperative
endothelial cell loss and graft rejection.
RESULTS: Five randomized controlled trials were selected for this meta-analysis, 
including 409 eyes (217 eyes in the DALK group and 192 eyes in the PK group).
Postoperative logarithm of the minimum angle of resolution BCVA and UCVA were
significantly better for PK than that for DALK [weighted mean difference (WMD) = 
0.04, 95% confidence interval (CI), 0.01-0.07, P = 0.005 and WMD = 0.12, 95% CI, 
0.05-0.18, P = 0.0007, respectively], whereas, the proportion of patients whose
postoperative best-corrected visual acuity ≥20/40 did not differ statistically
[risk ratio (RR) = 0.97, 95% CI, 0.89-1.07, P = 0.57]. There were no significant 
differences in terms of refractive error either by spherical equivalent or
astigmatism (P = 0.11 and P = 0.25, respectively). The endothelial cell loss
percentage in the PK group was significantly higher compared with the DALK group 
(WMD = -8.75, 95% CI, -15.25 to -2.25, P = 0.008). The DALK group was associated 
with a significantly lower frequency of graft rejection and endothelial rejection
than the PK group (RR = 0.48, 95% CI, 0.28-0.82, P = 0.007 and RR = 0.07, 95% CI,
0.01-0.35, P = 0.001, respectively).
CONCLUSIONS: DALK is an alternative surgical procedure for corneal stromal
pathologies without endothelial abnormalities, with lower efficacy but better
safety.

PMID: 26583281   [PubMed - as supplied by publisher]


2. Cornea. 2015 Nov 17. [Epub ahead of print]

Quantification and Patterns of Endothelial Cell Loss Due to Eye Bank Preparation 
and Injector Method in Descemet Membrane Endothelial Keratoplasty Tissues.

Schallhorn JM(1), Holiman JD, Stoeger CG, Chamberlain W.

Author information: 
(1)*Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science
University, Portland, Oregon; †Department of Ophthalmology, Keck School of
Medicine, University of Southern California, Los Angeles, CA; and ‡Lions
VisionGift, Portland, OR.

PURPOSE: To evaluate endothelial cell damage after eye bank preparation and
passage through 1 of 2 different injectors for Descemet membrane endothelial
keratoplasty grafts.
METHODS: Eighteen Descemet membrane endothelial keratoplasty grafts were prepared
by Lions VisionGift with the standard partial prepeel technique and placement of 
an S-stamp for orientation. The grafts were randomly assigned to injection with
either a glass-modified Jones tube injector (Gunther Weiss Scientific Glass) or a
closed-system intraocular lens injector (Viscoject 2.2; Medicel). After
injection, the grafts were stained with the vital fluorescent dye Calcein AM and 
digitally imaged. The percentage of cell loss was calculated by measuring the
area of nonfluorescent pixels and dividing it by the total graft area pixels.
RESULTS: Grafts injected using the modified Jones tube injector had an overall
cell loss of 27% ± 5% [95% confidence interval, 21%-35%]. Grafts injected using
the closed-system intraocular lens injector had a cell loss of 32% ± 8% (95%
confidence interval, 21%-45%). This difference was not statistically significant 
(P = 0.3). Several damage patterns including damage due to S-stamp placement were
observed, but they did not correlate with injector type.
CONCLUSIONS: In this in vitro study, there was no difference in the cell loss
associated with the injector method. Grafts in both groups sustained significant 
cell loss and displayed evidence of graft preparation and S-stamp placement.
Improvement in graft preparation and injection methods may improve cell
retention.

PMID: 26583280   [PubMed - as supplied by publisher]


3. Cornea. 2015 Nov 17. [Epub ahead of print]

Minocycline Inhibits Inflammation and Squamous Metaplasia of Conjunctival Tissue 
Culture in Airlift Conditions.

Xiao Q(1), Tan Y, Lin Z, Zhou J, Zhou F, Liu Z, Tang L.

Author information: 
(1)*Department of Ophthalmology, The Second Xiangya Hospital of Central South
University, Changsha, Hunan, China; †Department of Ophthalmology, The Second
Affiliated Hospital of Nanhua University, Hengyang, Hunan, China; and ‡Eye
Institute of Xiamen University, Xiamen, Fujian, China.

PURPOSE: Inflammation and squamous metaplasia is a common pathological process
that occurs in many ocular surface diseases such as dry eye, Stevens-Johnson
syndrome, mucous membrane pemphigoid, and chemical/thermal burns. At present,
there is no ideal medicinal treatment for this abnormality. We report herein on
an ex vivo conjunctival inflammation and squamous metaplasia model by culturing
human conjunctival tissues at an air-liquid interface for up to 8 days to study
the effects of minocycline on inflammation and squamous metaplasia.
METHODS: The levels of inflammatory mediators including interleukin-1β, tumor
necrosis factor-α, and metalloproteinase-9 in the cultured human conjunctival
tissues were determined by enzyme-linked immuno-sorbent assay and real-time
polymerase chain reaction. The total and phosphorylated nuclear factor-κB were
detected by western blot. Differentiation markers K10, MUC5AC, and Pax6 and
proliferation markers Ki67, p63, and K14 were determined by immunofluorescence or
immunohistochemical staining.
RESULTS: The results indicated that minocycline inhibited inflammation, decreased
the expression of interleukin-1β, tumor necrosis factor-α, and metalloproteinase 
-9, and squamous metaplasia features such as hyperproliferation and abnormal
epidermal differentiation of conjunctival epithelium.
CONCLUSIONS: These findings highlight the possibility that minocycline could be
used to treat dry eye and other ocular surface diseases exhibiting epithelial
cell inflammation and squamous metaplasia.

PMID: 26583279   [PubMed - as supplied by publisher]


4. Cornea. 2015 Nov 9. [Epub ahead of print]

Early Deep Anterior Lamellar Keratoplasty (DALK) for Acanthamoeba Keratitis
Poorly Responsive to Medical Treatment.

Sarnicola E(1), Sarnicola C, Sabatino F, Tosi GM, Perri P, Sarnicola V.

Author information: 
(1)*Department of Medicine, Surgery, and Neuroscience, University of Siena,
Siena, Italy; †Department of Biomedical and Specialty Surgical Sciences,
University of Ferrara, Ferrara, Italy; ‡Department of Ophthalmology, University
Campus Bio-Medico of Rome, Rome, Italy; and §Ambulatorio di Chirurgia Oculare
Santa Lucia, Grosseto, Italy.

PURPOSE: To evaluate the success (eradication of infection) or failure
(recurrence of infection in the cornea or sclera, or endophthalmitis) of early
therapeutic deep anterior lamellar keratoplasty (DALK) for active Acanthamoeba
keratitis (AK) poorly responsive to medical treatment.
METHODS: Retrospective, noncomparative case series of 11 patients (11 eyes)
affected by active AK poorly responsive to medical treatment who underwent early 
therapeutic DALK. Surgery was performed in all cases within 30 to 60 days from
the onset of symptoms. Corneal ulcer depth was less than 300 μm in all cases. A
3-drug combination (chlorhexidine gluconate, propamidine isethionate, and
neomycin sulfate) was the antiamoebic protocol used preoperatively and
postoperatively. Cannula big bubble and "layer-by-layer" manual dissection
techniques were performed. Eradication of infection, episodes of rejection,
postoperative endothelial cell density, and the best spectacle-corrected visual
acuity were evaluated. Histologic examination of surgical margins was performed, 
and margin clearance was assessed. Mean follow-up was approximately 2 years.
RESULTS: Four descemetic DALK and 7 predescemetic DALK were performed. One small 
Descemet membrane rupture occurred. Peripheral surgical margins were free of
infection in all cases. Deep surgical margins not free from infection were found 
in 2 cases. However, no episode of infection recurrence was observed. The
postoperative average best spectacle-corrected visual acuity was 0.8 (range,
0.6-1.0). No case of rejection was recorded.
CONCLUSIONS: Early therapeutic DALK could be considered a new approach to
eradicate active infection in AK cases poorly responsive to medical treatment,
with significant ulcer in the optical zone. Further studies are needed to
validate this new indication for DALK.

PMID: 26562819   [PubMed - as supplied by publisher]


5. Cornea. 2015 Nov 9. [Epub ahead of print]

Scanning Electron Microscopic Analysis of Biofilm Formation in Explanted Human
Boston Type I Keratoprostheses.

Sivaraman KR(1), Hou JH, Chang JH, Behlau I, Cortina MS, Cruz J.

Author information: 
(1)*Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear
Infirmary, University of Illinois at Chicago, Chicago, IL; †Bascom Palmer Eye
Institute, University of Miami Miller School of Medicine, Miami, FL; ‡Department 
of Ophthalmology, University of Minnesota, Minneapolis, MN; §Microbiology and
Molecular Biology and Ophthalmology, Tufts University School of Medicine, Boston,
MA; ¶Infectious Diseases, Mount Auburn Hospital, Cambridge, MA.

PURPOSE: To describe the morphological distribution of host tissue and microbial 
biofilms on the intraocular surfaces of Boston type I keratoprostheses (KPros)
explanted because of corneal melt.
METHODS: Retrospective study of scanning electron microscopy (SEM) images from 4 
explanted Boston type I KPros composed of polymethylmethacrylate and titanium.
SEM images of KPro-associated ocular surfaces were reviewed for the presence of
inflammatory cells, microbes, and/or biofilm formation. One sterile type I KPro
was also imaged to serve as a (device only) control.
RESULTS: All 4 KPros were explanted because of culture-negative, clinically
"sterile" donor corneal melt with impending KPro extrusion. In all cases, the
rough, irregular surfaces of the device harbored more adherent corneal epithelium
and stromacytes, inflammatory cells, and bacteria than the smooth, polished
surface of the KPro optic. Two KPros showed not only evidence of prior bacterial 
colonization but marked biofilm formation.
CONCLUSIONS: SEM images of explanted KPros explanted for "sterile" corneal melt
demonstrated evidence of biofilm formation despite negative donor corneal
cultures and the absence of clinical suspicion for infection. These results
suggest that "sterile" corneal melt may be due to inflammatory host responses to 
low microbial burdens as seen in biofilms and/or released antigens after
antibiotic-induced lysis. There was increased adherence of host tissue cells and 
microbial biofilms on the nonpolished surfaces of the KPro. Polishing the
intraocular polymethylmethacrylate and titanium KPro surfaces may decrease
microbial adhesion and biofilm formation in human subjects with KPros, but what
impact this will have on rates of postoperative endophthalmitis is unknown.

PMID: 26562818   [PubMed - as supplied by publisher]


6. Cornea. 2015 Nov 6. [Epub ahead of print]

Time Course of Antibiotic and Antifungal Concentrations in Corneal Organ Culture.

Seiler TG(1), Tschopp M, Zimmerli S, Tappeiner C, Wittwer VV, Frueh BE.

Author information: 
(1)Departments of *Ophthalmology; and †Infectious Diseases, Inselspital,
University of Bern, Bern, Switzerland.

PURPOSE: Contamination with bacteria and/or fungi is a serious complication in
organ-cultured corneas. Hence, antibiotic and antifungal agents are added to the 
culture medium. The concentration of different antimicrobial and antifungal
additives to the media over time has so far not been investigated in detail and
is the aim of this study.
METHODS: Nine human fresh corneoscleral discs were stored in corneal culture
medium consisting of 2% fetal bovine serum and minimal essential medium. In
addition, the culture medium contained 1200 μg/mL penicillin G, 25 μg/mL
amphotericin B, 120 μg/mL streptomycin, and 100 μg/mL voriconazole. The
concentration of amphotericin B used was 10 times higher than in clinical routine
to facilitate its detection. The cultures were kept at 37°C for 28 days. At days 
0, 7, 14, 21, and 28, samples of the culture medium were harvested for analysis
of antimicrobial concentrations by liquid chromatography and electrospray
ionization tandem mass spectrometry.
RESULTS: During corneal storage, the concentration of all antibiotics and
antifungal agents declined significantly. By day 28, penicillin G was reduced to 
14% of the original concentration. Amphotericin B and streptomycin retained
approximately 60% of the original concentration to the end of the experiment and 
voriconazole maintained stable concentrations after an initial decline to
approximately 80% at 7 days.
CONCLUSIONS: Throughout the entire storage period, the concentrations of
penicillin G, streptomycin, and voriconazole exceeded the minimum inhibitory
concentrations of all common contaminants, obviating the need for a change of the
medium for antimicrobial reasons. Based on the minimum inhibitory concentrations 
and our findings, the initial concentration of amphotericin B should be raised to
5 μg/mL.

PMID: 26555594   [PubMed - as supplied by publisher]


7. Cornea. 2015 Nov 6. [Epub ahead of print]

Infectious Keratitis in Limbal Stem Cell Deficiency: Stevens-Johnson Syndrome
Versus Chemical Burn.

Kang BS(1), Kim MK, Wee WR, Oh JY.

Author information: 
(1)*Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea; and †Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical
Research Institute, Seoul National University Hospital, Seoul, Korea.

PURPOSE: To investigate the incidence, clinical and microbiological
characteristics, risk factors, and therapeutic outcome of infectious keratitis in
patients with limbal stem cell deficiency (LSCD) related to Stevens-Johnson
syndrome (SJS) and corneal chemical burn.
METHODS: Medical records of 90 eyes of 59 patients who were diagnosed with LSCD
resulting from SJS (52 eyes of 29 patients) or corneal chemical burn (38 eyes of 
30 patients) were reviewed.
RESULTS: Infectious keratitis developed in 35% of LSCD patients with SJS (18
eyes, 14 patients) and in 18% of those with chemical burn (7 eyes, 7 patients).
The development of infectious keratitis in SJS was significantly associated with 
the severity of chronic ocular surface complications in the cornea, conjunctiva, 
and eyelids and with the use of topical corticosteroids during the disease
course. All cases of infectious keratitis following chemical burn occurred in
patients with grade III or IV burn by Roper-Hall classification. Approximately
83% of culture-proven cases of infectious keratitis were bacterial infection,
most of which (80%) were caused by Gram-positive bacteria. For resolution of
infection, 17 eyes (68%) received surgery in addition to medical treatment,
whereas 8 eyes (32%) received medical treatment alone. After infection
resolution, the final visual acuity was decreased in 10 eyes (40%) compared with 
before infection.
CONCLUSIONS: Infectious keratitis is a common complication of LSCD associated
with SJS or severe chemical burn to the cornea. Despite medical and surgical
treatments, the visual outcome is poor.

PMID: 26555593   [PubMed - as supplied by publisher]


8. Cornea. 2015 Nov 6. [Epub ahead of print]

Single-Pass Dissection of Ultrathin Organ-Cultured Endothelial Lamellae Using an 
Innovative Microkeratome System.

Dickman MM(1), Kruit PJ, van den Biggelaar FJ, Berendschot TT, Nuijts RM.

Author information: 
(1)*Maastricht University Medical Center, University Eye Clinic Maastricht,
Maastricht, the Netherlands; and †Euro Cornea Bank, Beverwijk, the Netherlands.

PURPOSE: To determine the feasibility, dissection accuracy, and endothelial
viability of ultrathin endothelial lamellae harvested from organ-cultured corneas
using a single-pass with an innovative motor-driven linear microkeratome system.
METHODS: Forty-eight (n = 48) paired organ-cultured human corneas were randomly
assigned to dissection (study eyes, n = 24) with fellow eyes serving as the
control (fellow eyes, n = 24). After organ culture and deswelling in a medium
containing 6% dextran, endothelial lamellae with a target thickness ≤100 μm were 
dissected using a motor-driven linear microkeratome system (SLc, Gebauer,
Neuhausen, Germany) equipped with 400-μm (n = 4), 450-μm (n = 10), 500-μm (n =
5), or 550-μm (n = 5) heads. Central corneal thickness (CCT) and posterior and
anterior lamellar thicknesses were measured using ultrasound pachymetry (Pachette
3; DGH Technology Inc, PA) and anterior segment optical coherence tomography
(Casia SS-1000; Tomey, Nagoya, Japan). Endothelial viability [endothelial cell
density (ECD)] was measured using trypan vital staining.
RESULTS: CCT measured 595 ± 66 μm (n = 48) on arrival, 846 ± 131 μm (n = 48)
after organ culture, and 565 ± 58 μm (n = 48) after deturgescence. CCT did not
differ between study and control eyes. Posterior lamellar thickness measured 88 ±
18 μm (n = 24) immediately after dissection, 126 ± 30 μm (n = 24) 1 hour after
dissection, and 131 ± 41 μm (n = 24) 2.3 ± 0.6 days after dissection. ECD
measured 2637 ± 264 cells per square millimeter (n = 48) on arrival, 2524 ± 232
cells per square millimeter (n = 48) after organ culture, 2493 ± 253 cells per
square millimeter (n = 48) after dissection, and 2311 ± 218 cells per square
millimeter (n = 48) 2.3 ± 0.6 days after dissection. ECD did not differ between
study and control eyes at all time points.
CONCLUSIONS: Single-pass motor-driven linear microkeratome dissection provides an
accurate and safe alternative for harvesting ultrathin endothelial lamellae from 
organ-cultured donor corneas.

PMID: 26555592   [PubMed - as supplied by publisher]


9. Cornea. 2015 Nov 6. [Epub ahead of print]

Long-Term Results of Phototherapeutic Keratectomy Versus Mechanical Epithelial
Removal Followed by Corneal Collagen Cross-Linking for Keratoconus.

Kapasi M(1), Dhaliwal A, Mintsioulis G, Jackson WB, Baig K.

Author information: 
(1)*Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada;
and †Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

PURPOSE: To compare the long-term visual outcomes of patients with keratoconus
treated with either phototherapeutic keratectomy (PTK) or mechanical epithelial
removal before corneal collagen cross-linking (CXL) at 1, 3, 6, and 12 months
postoperatively.
METHODS: CXL was performed by 1 of 3 surgeons (K.B., W.B.J., or G.M.). Seventeen 
eyes underwent mechanical epithelial removal before CXL and were consecutively
selected after being matched with the 17 eyes in the PTK group for the variables 
of procedure date, average keratometry, and pachymetry. All cones were central.
Manifest refraction spherical equivalent, sphere, cylinder, corrected distance
visual acuity (CDVA), and pachymetry were measured and compared preoperatively
and in follow-up.
RESULTS: The mean CDVA change in the PTK group at 12 months postoperatively was
statistically different from the mean CDVA change in the mechanical group at 12
months postoperatively (P = 0.031). The PTK group had significantly better
outcomes in visual acuity 12 months postoperatively than did the mechanical group
(P > 0.05). The mean number of lines of improvement in the PTK and mechanical
groups were 2.30 ± 0.96 and 0.00 ± 0.33 lines, respectively (P = 0.0036). The
mean change between the preoperative and 12 months postoperative manifest
refraction spherical equivalent for the PTK and mechanical groups were 0.78 ±
0.65 and 0.17 ± 0.65, respectively (P > 0.05).
CONCLUSIONS: PTK CXL resulted in better visual outcomes in comparison with
mechanical epithelial removal CXL 1 year after treatment.

PMID: 26555591   [PubMed - as supplied by publisher]


10. Cornea. 2015 Nov 6. [Epub ahead of print]

Safety of Intracameral Injection of Minimal Bactericidal Concentration of
Povidone Iodine on the Corneal Endothelium in a Rabbit Model.

ElKitkat RS(1), Ebeid WM, Habib EK, Shoukry Y.

Author information: 
(1)Departments of *Ophthalmology; and †Anatomy and Embryology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt.

PURPOSE: To investigate the safety of intracameral injection of minimum
bactericidal concentration (MBC) of povidone iodine (PI) on the corneal
endothelium in a rabbit model as a proposed method of prophylaxis against
postoperative endophthalmitis.
METHODS: We included 32 New Zealand white rabbits in the study. Twenty-four
rabbits received intracameral injections of 0.1 mL of 0.25% PI, and they were
sequentially killed at intervals; first, seventh, and 14th day. The control group
included 4 rabbits that received intracameral injections of 0.1 mL normal saline,
and 4 rabbits that underwent the same intraocular procedure without injections
(sham operated). Slit-lamp examination and ultrasonic corneal pachymetry were
performed before and after injections for both eyes. The corneas were
histopathologically examined by light and electron microscopy.
RESULTS: MBC of PI (0.25%) was toxic to rabbits' corneal endothelium as evident
by histopathological changes, corneal edema, and increased corneal thickness on
day 1. Signs of healing were obvious on day 7 and were almost complete on day 14,
as detected by histopathology, subsidence of corneal edema, and normalization of 
corneal thickness.
CONCLUSIONS: MBC (0.25%) of PI was found toxic to the rabbits' corneal
endothelium, with progressive regeneration and complete healing within 2 weeks.
To our knowledge, we are the first to use MBC of PI in intracameral injection
trials. Further studies on primates, which have more comparable regenerative
capacity to humans' corneal endothelium, are encouraged to evaluate their
endothelial healing response.

PMID: 26555590   [PubMed - as supplied by publisher]


11. Cornea. 2015 Nov 6. [Epub ahead of print]

Formation of Segmental Rounded Nodules During Infiltration of Adult T-Cell
Leukemia Cells Into the Ocular Mucous Membrane.

Kamoi K(1), Nagata Y, Mochizuki M, Kobayashi D, Ohno N, Uchimaru K, Tojo A,
Ohno-Matsui K.

Author information: 
(1)*Department of Ophthalmology and Visual Science, Graduate School of Medical
and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan;
†Department of Ophthalmology, Research Hospital, The Institute of Medical
Science, The University of Tokyo, Tokyo, Japan; ‡Department of Human Pathology,
Graduate School of Medical and Dental Science, Tokyo Medical and Dental
University, Tokyo, Japan; and §Department of Hematology/Oncology, Research
Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo,
Japan.

PURPOSE: To document a case of adult T-cell leukemia (ATL) cell infiltration into
the ocular mucous membrane that presented with rounded nodule formation.
METHODS: Observational case report.
RESULTS: A 36-year-old woman presented with bilateral conjunctival hyperemia and 
small papules on the legs and face. After complaining of significant fatigue at 6
months, she was diagnosed with high-risk chronic-type ATL. Ophthalmic examination
revealed the formation of bilateral segmental rounded nodules, which were located
both at the bulbar conjunctiva around the corneal limbus and at the palpebral
conjunctiva around each lacrimal punctum. Although cellular infiltrations were
also seen at the corneal subepithelium and stroma, no cellular infiltrations were
observed in the anterior chamber, vitreous, or retina. Biopsy was performed of
the bulbar and palpebral conjunctiva, and the polymerase chain reaction detected 
HTLV-1 proviral DNA and monoclonal T-cell receptor γ-chain gene rearrangement in 
both samples. Pathological evaluations identified atypical lymphoid cells that
were consistent with ATL cells. These analyses confirmed that the rounded nodules
were formed in conjunction with the infiltration of ATL cells.
CONCLUSIONS: The formation of multiple rounded nodules during ATL cell
infiltration into the ocular mucous membrane, especially at the palpebral
conjunctiva around the lacrimal punctum, may be a distinguishing feature of ATL.

PMID: 26555589   [PubMed - as supplied by publisher]


12. Cornea. 2015 Nov 6. [Epub ahead of print]

Nitrogen Mustard-Induced Corneal Injury Involves DNA Damage and Pathways Related 
to Inflammation, Epithelial-Stromal Separation, and Neovascularization.

Goswami DG(1), Tewari-Singh N, Dhar D, Kumar D, Agarwal C, Ammar DA, Kant R,
Enzenauer RW, Petrash JM, Agarwal R.

Author information: 
(1)Departments of *Pharmaceutical Sciences; and †Ophthalmology, University of
Colorado Anschutz Medical Campus, Aurora, CO.

PURPOSE: To evaluate the toxic effects and associated mechanisms in corneal
tissue exposed to the vesicating agent, nitrogen mustard (NM), a bifunctional
alkylating analog of the chemical warfare agent sulfur mustard.
METHODS: Toxic effects and associated mechanisms were examined in maximally
affected corneal tissue using corneal cultures and human corneal epithelial (HCE)
cells exposed to NM.
RESULTS: Analysis of ex vivo rabbit corneas showed that NM exposure increased
apoptotic cell death, epithelial thickness, epithelial-stromal separation, and
levels of vascular endothelial growth factor, cyclooxygenase 2, and matrix
metalloproteinase-9. In HCE cells, NM exposure resulted in a dose-dependent
decrease in cell viability and proliferation, which was associated with DNA
damage in terms of an increase in p53 ser15, total p53, and H2A.X ser139 levels. 
NM exposure also induced caspase-3 and poly ADP ribose polymerase cleavage,
suggesting their involvement in NM-induced apoptotic death in the rabbit cornea
and HCE cells. Similar to rabbit cornea, NM exposure caused an increase in
cyclooxygenase 2, matrix metalloproteinase-9, and vascular endothelial growth
factor levels in HCE cells, indicating a role of these molecules and related
pathways in NM-induced corneal inflammation, epithelial-stromal separation, and
neovascularization. NM exposure also induced activation of activator protein 1
transcription factor proteins and upstream signaling pathways including
mitogen-activated protein kinases and Akt protein kinase, suggesting that these
could be key factors involved in NM-induced corneal injury.
CONCLUSIONS: Results from this study provide insight into the molecular targets
and pathways that could be involved in NM-induced corneal injuries laying the
background for further investigation of these pathways in vesicant-induced ocular
injuries, which could be helpful in the development of targeted therapies.

PMID: 26555588   [PubMed - as supplied by publisher]


13. Cornea. 2015 Nov 6. [Epub ahead of print]

Potency and Sterility of Fortified Tobramycin, Fortified Vancomycin, and
Moxifloxacin at 4, 24, and 35°C for 14 Days.

Montes JA(1), Johnson D, Jorgensen J, McElmeel ML, Fulcher LC, Kiel JW.

Author information: 
(1)Department of Ophthalmology, University of Texas Health Science Center at San 
Antonio, San Antonio, TX.

PURPOSE: To assess the potency and sterility of ophthalmic antibiotic drops
commonly used in the treatment of bacterial keratitis.
METHODS: This was a basic investigation. Three drugs were tested: fortified
vancomycin 25 mg/mL, fortified tobramycin 14 mg/mL, and moxifloxacin 5 mg/mL. A
bottle of each was stored separately at 4, 24, and 35°C, with the potency
determined by microbiological assay at 0, 7, and 14 days. Differences in potency 
were assessed by 2-way analysis of variance followed by a 1-way repeated-measures
analysis of variance with Bonferroni post hoc testing as warranted. Sterility of 
drugs when handled by patients for varying periods was confirmed by culturing
samples on MacConkey and sheep blood agars.
RESULTS: The concentration of fortified tobramycin and moxifloxacin remained
constant over 14 days at the 3 tested temperatures. The concentration of
fortified vancomycin remained constant at 4°C, but it declined by 38% ± 1% (P =
0.001) at 24°C on day 14 and by 48% ± 1% (P = 0.001) and 78% ± 3% (P = 0.0009) at
35°C on days 7 and 14, respectively. A total of 49 drops (mean, 7.3 days; range, 
1-18 days) were tested for sterility, and all were negative for microbial
contamination.
CONCLUSIONS: All 3 drugs remained potent at 4°C for up to 14 days. Fortified
tobramycin and moxifloxacin also maintained potency for 14 days at 24 and 35°C.
In contrast, fortified vancomycin lost its potency by day 14 at 24°C and by day 7
at 35°C. All in-use antibiotic drops tested were sterile. The results indicate
that patients should be cautioned to store vancomycin under refrigerator or at
least under cool conditions.

PMID: 26555587   [PubMed - as supplied by publisher]


14. Cornea. 2015 Nov 6. [Epub ahead of print]

Corneal Diameter as a Factor Influencing Corneal Astigmatism After Cataract
Surgery.

Sofia T(1), Ioannis A, Christos K, Aristidis A, Miltiadis A.

Author information: 
(1)*Department of Ophthalmology, Medical School, University of Ioannina,
Ioannina, Greece; and †Ophthalmology Clinic, General Hospital of Piraeus
"Tzaneio," Attiki, Greece.

PURPOSE: To evaluate the corneal horizontal diameter [white-to-white (WTW)
distance] as a factor influencing surgically induced astigmatism (SIA) and
postoperative astigmatism.
METHODS: A total of 330 eyes with corneal astigmatism ≤1.5 D underwent cataract
surgery with phacoemulsification. A 3-step, superotemporal for the right eye and 
superonasal for the left eye, clear corneal incision of 3.0 mm was made. Four
groups were created according to WTW distance: group A ≤11.6 mm, group B 11.7 to 
11.9 mm, group C 12.0 to 12.2 mm, and group D ≥12.3 mm. SIA was calculated by
vector analysis using the Alpins method. We noted all cases, in which a change
greater than 0.5 diopters (D) in astigmatism took place and a change greater than
20 degrees in axis torque, despite axis direction, on the first and sixth
postoperative months.
RESULTS: SIA was found in group A 0.98 D ± 0.6 (SD), B 0.79 D ± 0.43 (SD), C 0.68
D ± 0.45 (SD), and D 0.53 D ± 0.32 (SD) at the first postoperative month. At the 
sixth postoperative month, SIA was 0.77 D ± 0.43 (SD), 0.69 D ± 0.34 (SD), 0.62 ±
0.36 (SD), and 0.49 D ± 0.27 (SD), respectively. A change greater than 0.5 D in
corneal astigmatic power at the first and sixth months postoperatively was
significantly lower in eyes with WTW distance 12.0 to 12.2 mm and ≥12.3 mm in
comparison with eyes with WTW distance ≤11.6 mm and 11.7 to 11.9 mm (P < 0.05).
Changes greater than 20 degrees in astigmatic axis at the first and sixth
postoperative months were not significantly different according to the horizontal
corneal diameter.
CONCLUSIONS: WTW distance should always be measured preoperatively when planning 
cataract surgery and should be accounted for in cases of large and small corneas.

PMID: 26555586   [PubMed - as supplied by publisher]


15. Cornea. 2015 Nov 6. [Epub ahead of print]

Treatment Modalities and Clinical Outcomes in Ocular Sequelae of Stevens-Johnson 
Syndrome Over 25 Years-A Paradigm Shift.

Iyer G(1), Srinivasan B, Agarwal S, Pillai VS, Ahuja A.

Author information: 
(1)CJ Shah Cornea Services, Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface
Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India.

PURPOSE: To highlight and compare the outcomes of management for the ocular
sequelae of Stevens-Johnson syndrome (SJS) over 25 years in a tertiary eye care
institute.
METHODS: A retrospective chart review of 798 eyes of 399 patients with SJS
evaluated between January 1990 and December 2004 (group I) and of 847 eyes of 517
patients between January 2005 and December 2014 (group II) was done. The primary 
and secondary outcome measures were a change in the best-corrected visual acuity 
(BCVA) and an improvement in the symptoms and the ocular surface status,
respectively. The groups were subdivided into procedures for ocular surface
stabilization (A) and visual rehabilitation (B) and those managed conservatively 
(C).
RESULTS: In the subgroup A of group II, an improvement/stabilization of BCVA
after punctal cautery (231 eyes), mucous membrane grafting for lid margin
keratinization (393 eyes), and fornix reconstruction (28 eyes) was noted in 93.6%
of eyes. In subgroup B, all 10 eyes that underwent limbal allograft in group I
failed when compared with an improvement of BCVA to better than 20/200 in 65.5%
of the 61 eyes that underwent keratoprostheses. It was noted that the limbal
status worsened in 66.9% of eyes treated conservatively in group I.
CONCLUSIONS: Stabilization procedures show a beneficial role while conservative
management can lead to deterioration in chronic ocular sequelae of SJS.
Keratoprosthesis, specifically the modified osteo-odonto-keratoprosthesis, forms 
the mainstay for visual rehabilitation in the end-stage disease. This study
highlights the improved outcomes with a paradigm shift in the management
modalities.

PMID: 26555585   [PubMed - as supplied by publisher]


16. Cornea. 2015 Nov 6. [Epub ahead of print]

Changes in Corneal Biomechanical Properties After Descemet Stripping Automated
Endothelial Keratoplasty for Pseudophakic Bullous Keratopathy.

Faramarzi A(1), Feizi S, Najdi D, Ghiasian L, Karimian F.

Author information: 
(1)Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad
Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

PURPOSE: To compare corneal biomechanical properties and intraocular pressure
(IOP) in eyes with pseudophakic bullous keratopathy (PBK) before and after
Descemet stripping automated endothelial keratoplasty (DSAEK).
METHODS: This prospective nonrandomized intrasubject comparative study was
conducted on 44 eyes of 22 patients with the diagnosis of PBK who underwent DSAEK
in one eye. IOP was measured by Goldmann applanation tonometer, and central
corneal thickness was measured by ultrasound pachymetry. The ocular response
analyzer was used to measure corneal hysteresis (CH), corneal resistance factor
(CRF), Goldmann-related IOP, and cornea-compensated IOP. The same measurements
were performed in the normal fellow eyes which served as controls. All
measurements were performed preoperatively and 6 months postoperatively.
RESULTS: The mean patient age was 67 ± 14 years. Mean preoperative CH and CRF
values in the DSAEK group were 5.77 ± 2.94 and 6.39 ± 2.72 mm Hg, respectively,
which were significantly lower than those measured in the control group (8.2 ±
2.47 and 8.43 ± 2.49 mm Hg, respectively, P = 0.001 for both comparisons).
Postoperatively, CH and CRF demonstrated a significant increase (7.09 ± 3.68 mm
Hg, P = 0.05 and 8.21 ± 3.84 mm Hg, P = 0.03, respectively) in operated eyes
approaching the normal values measured in the control eyes.
CONCLUSIONS: Corneal biomechanical parameters were significantly lower in PBK
eyes than in the normal fellow eyes. These metrics significantly increased after 
DSAEK and reached values measured in the normal fellow eyes.

PMID: 26555584   [PubMed - as supplied by publisher]


17. Cornea. 2015 Nov 6. [Epub ahead of print]

Single-Pass Microkeratome System for Eye Bank DSAEK Tissue Preparation: Is
Stromal Bed Thickness Predictable and Reproducible?

Choulakian MY(1), Li JY, Ramos S, Mannis MJ.

Author information: 
(1)*Department of Ophthalmology and Visual Science, University of California
Davis, Sacramento, CA; and †Sierra Donor Services Eye Bank, Sacramento, CA.

PURPOSE: To evaluate the predictability and reproducibility of stromal bed
thickness for single-pass donor Descemet stripping automated endothelial
keratoplasty (DSAEK) tissue preparation, using the ML7 Microkeratome Donor Cornea
System (Med-logics Inc, Athens, TX).
METHODS: In this retrospective chart review of 256 consecutive corneal tissue
preparations for DSAEK surgery, from June 2013 to August 2014, tissue thicknesses
were divided into 3 groups, depending on surgeon preference: <91 μm (group A), 90
to 120 μm (group B), and 120 to 160 μm (group C). Precut and postcut data were
recorded.
RESULTS: Average postcut donor corneal thickness was 114 ± 30 μm (range 60-183
μm), whereas the average in group A was 97 ± 23 μm (range 60-128), in group B was
113 ± 21 μm (range 77-179), and in group C was 134 ± 43 (range 89-183). Average
postcut endothelial cell density was very adequate at 3013 ± 250 cells per square
millimeter. There were a total of 7 failed procedures from 256 attempts, which
represents a rate of 2.7%. This rate decreases to 1.5% when analyzing the last
200 cuts.
CONCLUSIONS: The ML7 Microkeratome Donor Cornea System allows for reliable and
reproducible DSAEK tissue preparation. Ultrathin DSAEK tissues can be prepared
with a single-pass. Aiming for a graft thickness between 90 and 120 μm seems to
be most reliable.

PMID: 26555583   [PubMed - as supplied by publisher]


18. Cornea. 2015 Nov 6. [Epub ahead of print]

Immediate Postoperative Intraocular Pressure Changes After Anterior Chamber Air
Fill in Descemet Membrane Endothelial Keratoplasty.

Stanzel TP(1), Ersoy L, Sansanayudh W, Felsch M, Dietlein T, Bachmann B,
Cursiefen C.

Author information: 
(1)*Department of Ophthalmology, University of Cologne, Cologne, Germany;
†Department of Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand; and
‡Institute for Medical Statistics, Informatics and Epidemiology, University of
Cologne, Germany.

PURPOSE: To monitor the intraocular pressure (IOP) changes immediately after
anterior chamber air tamponade in Descemet membrane endothelial keratoplasty
(DMEK).
METHODS: Twenty-four patients undergoing DMEK and 16 patients undergoing
rebubbling after DMEK were enrolled (n = 40). All DMEK patients had inferior
iridectomy and nearly full intracameral air tamponade with an aimed IOP of 25 mm 
Hg at the end of surgery. The IOP was measured at 1, 2, 3, 5, 12, 24 hours and 1 
week postoperatively.
RESULTS: After anterior chamber air fill in DMEK, the IOP increased from
preoperative baseline, 12.1 ± 2.9 mm Hg, to 26.3 ± 4.7 mm Hg, P < 0.001. Mean IOP
was significantly elevated in the first 2 hours, 19.4 ± 10.5 mm Hg and 17.0 ± 7.4
mm Hg, P = 0.007 and 0.006, respectively. Then, it lowered to the baseline level,
14.0 ± 4.7 mm Hg, P > 0.05, and remained stable during follow-ups. An
asymptomatic IOP elevation above 30 mm Hg was detected in 3 patients (12.5%)
within the first 2 hours. None had preexisting glaucoma. Most episodes could be
controlled by antiglaucoma medications and upright positioning. The pattern of
IOP changes after rebubbling was similar to that after DMEK but the IOP dropped
sharply to the baseline level after 1 hour and had no incidence of IOP elevations
beyond 30 mm Hg.
CONCLUSIONS: Adequate inferior iridectomy greatly alleviates the risk and
severity of acute IOP rises after nearly full anterior chamber air tamponade in
DMEK. Standard IOP adjustment at the end of DMEK surgery with postoperative IOP
monitoring especially in the first 2 postoperative hours is advisable when there 
is no postoperative default air release.

PMID: 26555582   [PubMed - as supplied by publisher]


19. Cornea. 2015 Nov 6. [Epub ahead of print]

Cytokine Dosage in Fresh and Preserved Human Amniotic Membrane.

Bomfim Pereira MG(1), Pereira Gomes JA, Rizzo LV, Cristovam PC, Silveira LC.

Author information: 
(1)*Department of Ophthalmology, Federal University of São Paulo, São Paulo,
Brazil; †Albert Einstein Israelite Hospital, São Paulo, Brazil; and ‡Department
of Ophthalmology, Federal University of Minas Gerais.

PURPOSE: To evaluate cytokine concentrations in amniotic membrane (AM) preserved 
in different preservation media, temperatures, and times and to compare them with
those in fresh AM.
METHODS: Placentas were harvested from 8 women undergoing cesarean delivery, with
each then divided into 17 pieces for the following preservation methods: at 2
different temperatures (-80 and 0°C), in 2 different preservation media (dimethyl
sulfoxide and enriched TC199; Ophthalmos), and for different time periods (for 1,
7, 60, and 180 days). Nonpreserved fresh AM was used as a control. An
enzyme-linked immunosorbent assay was performed on the supernatant for detection 
of the following cytokines: epidermal growth factor, basic fibroblast growth
factor, hepatocyte growth factor, keratinocyte growth factor, transforming growth
factor-beta, and interleukins 4 and 10, and the findings were assessed by post
hoc analysis of variance.
RESULTS: AM preserved at -80°C showed less decrease in the concentration of 4
cytokines. Three cytokines showed less decrease in AM preserved in the TC199
medium, whereas 1 showed less decrease in AM preserved in dimethyl sulfoxide.
After storage, 5 cytokine concentrations remained stable for up to 1 day, 3
remained stable for up to 7 days, and all showed significant loss thereafter.
CONCLUSIONS: The AM storage temperature of -80°C was found optimal for
maintaining the concentrations of most of the tested cytokines, and enriched
TC199 medium was the optimal long-term storage medium for maintaining the
concentration of 3 of the cytokines, and with less decrease. When possible, AM
should be used within 1 to 7 days after harvesting.

PMID: 26555581   [PubMed - as supplied by publisher]


20. Cornea. 2015 Nov 6. [Epub ahead of print]

Confocal Microscopic Analysis of a Rabbit Eye Model of High-Incidence Recurrent
Herpes Stromal Keratitis.

Jester JV(1), Morishige N, BenMohamed L, Brown DJ, Osorio N, Hsiang C, Perng GC, 
Jones C, Wechsler SL.

Author information: 
(1)*Gavin Herbert Eye Institute, University of California Irvine, School of
Medicine, Irvine, CA; †Department of Biomedical Engineering, University of
Irvine, Irvine; ‡Department of Ophthalmology, Yamaguchi University Graduate
School of Medicine, Yamaguchi, Japan; §Cellular and Molecular Immunology
Laboratory, University of California Irvine, Irvine, CA ¶Institute for
Immunology, University of California Irvine, Irvine, CA ‖Department of
Microbiology and Immunology, National Cheng Kung University, Tainan Taiwan;
**School of Veterinary Medicine and Biomedical Sciences, Nebraska Center for
Virology, University of Nebraska, Lincoln, NE; ††Department of Microbiology and
Molecular Genetics, University of California Irvine, School of Medicine, Irvine, 
CA; and ‡‡The Center for Virus Research, University of California, Irvine,
Irvine, CA.

PURPOSE: Using CJLAT, a chimeric herpes simplex virus (HSV-1) that produces a
high incidence of herpes stromal keratitis (HSK) in latently infected rabbits,
and in vivo confocal microscopy (CM), we characterized the cellular events that
precede the development of HSK.
METHODS: Thirty days after infection, in vivo CM was performed daily for 10 days 
and then weekly for up to 80 days after infection.
RESULTS: We detected 3 types of subclinical corneal lesions before HSK was
clinically apparent: (1) small epithelial erosions; (2) regenerating epithelium
overlying small cell infiltrates within the basal epithelial cell layer; and (3) 
dendritic-like cells within the basal epithelial layer overlying stromal foci
containing infiltrating cells. Sequential in vivo CM observations suggested that 
subclinical foci resolved over time but were larger and more abundant with CJLAT 
than with wild-type HSV-1 McKrae. Active HSK was observed only with CJLAT and was
initially associated with a large epithelial lesion overlying stromal immune cell
infiltrates.
CONCLUSIONS: These results suggest that replication in the cornea of reactivated 
virus from the trigeminal ganglia produces epithelial lesions, which recruit
immune cell infiltrates into the basal epithelial layer and anterior stroma. The 
virus is usually cleared rapidly eliminating viral antigens before the arrival of
the immune cells, which disperse. However, if the virus is not cleared rapidly,
or if an additional reactivation results in an additional round of virus at the
same site before the immune cells disperse, then the immune cells are stimulated 
and may induce an immunopathological response leading to the development of HSK.

PMID: 26555580   [PubMed - as supplied by publisher]


21. Cornea. 2015 Nov 6. [Epub ahead of print]

Corneal Indocyanine Green Angiography to Guide Medical and Surgical Management of
Corneal Neovascularization.

Steger B(1), Romano V, Kaye SB.

Author information: 
(1)*Department of Corneal and External Eye Diseases, St. Paul's Eye Unit, Royal
Liverpool University Hospital, Liverpool, United Kingdom; †Department of
Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria; and
‡Department of Eye and Vision Science, University of Liverpool, Liverpool, United
Kingdom.

PURPOSE: To illustrate the role of corneal angiography in the clinical assessment
and surgical treatment of patients with complex corneal neovascularization
(CoNV).
METHODS: A case series of 3 patients with CoNV is presented whose management was 
guided by indocyanine green (ICG) and fluorescein corneal angiography. In the
first case, there was recurrent lipid exudation into an intrastromal cleft from
CoNV; in the second, there was progressive exudation from CoNV at the graft-host 
interface; in the third, CoNV was associated with rejection after deep anterior
lamellar keratoplasty.
RESULTS: In the first case, angiography helped to identify and treat the feeder
vessels and stop further leakage. In the second case, it was possible using
angiography to differentiate CoNV arising from iris and limbal vasculature
enabling angiographic-guided fine-needle diathermy with cessation of exudation.
In the third case, angiography revealed the location of CoNV in the host-graft
interface after deep anterior lamellar keratoplasty, rather than within the
corneal stroma.
CONCLUSIONS: Corneal angiography is a useful diagnostic tool to guide medical and
surgical management of CoNV by enabling the localization of vessel depth and
topography.

PMID: 26555579   [PubMed - as supplied by publisher]


22. Cornea. 2015 Dec;34(12):e40. doi: 10.1097/ICO.0000000000000672.

Corneal Microstructural Changes in Nerve Fiber, Endothelial and Epithelial
Density After Cataract Surgery in Patients With Diabetes Mellitus: Erratum.

[No authors listed]

PMID: 26544681   [PubMed - in process]


23. Cornea. 2015 Dec;34(12):1620-2. doi: 10.1097/ICO.0000000000000658.

Atypical Fibroxanthoma of the Bulbar Conjunctiva.

Shieh C(1), Daluvoy MB, Ellington KS, Proia AD.

Author information: 
(1)Departments of *Ophthalmology; and †Pathology, Duke University Medical Center,
Durham, NC.

PURPOSE: To report a rare case of atypical fibroxanthoma (AFX) of the bulbar
conjunctiva, and to compare it with previously published cases of conjunctival
AFX.
METHODS: A 37-year-old woman developed a growth on the bulbar conjunctiva of her 
left eye that increased in size and redness over 4 months and was associated with
blurry vision in the left eye, occasional diplopia, irritation of the eye, and
increasing tearing. The mass was surgically excised.
RESULTS: Slit-lamp examination disclosed a highly vascularized conjunctival
lesion with intact lustrous epithelium and a raised nodular edge encroaching on
the nasal corneal limbus of the left eye. Pathological examination and
immunohistochemistry were diagnostic of AFX.
CONCLUSIONS: AFX of the conjunctiva is rare, with this being only the fifth
example of this neoplasm reported at this site. Complete surgical excision is the
most appropriate treatment option.

PMID: 26509771   [PubMed - in process]


24. Cornea. 2015 Oct 27. [Epub ahead of print]

Comparison of Descemet-On Versus Descemet-Off Deep Anterior Lamellar Keratoplasty
in Keratoconus Patients: A Randomized Trial.

Goyal P(1), Sureka SP, Das S.

Author information: 
(1)*L V Prasad Eye Institute, Bhubaneswar, India †Cornea and Anterior Segment
Services, L V Prasad Eye Institute, Bhubaneswar, India.

PMID: 26509770   [PubMed - as supplied by publisher]


25. Cornea. 2015 Oct 27. [Epub ahead of print]

Efficacy and Safety of Carbomer-Based Lipid-Containing Artificial Tear
Formulations in Patients With Dry Eye Syndrome.

Chung SH(1), Lim SA, Tchach H.

Author information: 
(1)*Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Korea; and
†Department of Ophthalmology, Asan Medical Center, University of Ulsan College of
Medicine, Seoul, Korea.

PURPOSE: To evaluate the efficacy and safety profile of carbomer-based
lipid-containing artificial tear formulations (CBLAT) in patients with dry eye
syndrome.
METHODS: A multicenter parallel-group study was conducted in 412 patients with
dry eye syndrome. Of these patients, 221 switched from using artificial tears to 
CBLAT (switching group) and 191 added CBLAT to their current treatment (add-on
group). Ocular symptom scores, ocular staining grades, tear film breakup time
(tBUT), Schirmer I test value, and Korean dry eye level (as defined by the Korean
Corneal Disease Study Group guidelines) were evaluated at baseline and after 4
weeks of treatment.
RESULTS: After 4 weeks of treatment, ocular surface staining grade, tBUT,
Schirmer I value, ocular irritation symptom scores, and the positive rate of
visual symptom improved significantly in both groups. Mean reductions in ocular
surface staining grades (-0.8 ± 0.9) and ocular irritation symptom scores (-0.8 ±
0.8) in the add-on group were significantly higher than those (-0.5 ± 0.8 and
-0.6 ± 0.8) in the switching group (P < 0.01 and P < 0.05). The positive rate of 
visual symptoms (44.2%) in the add-on group was significantly higher than that
(26.4%) in the switching group (P < 0.01). The decrease of Korean dry eye level
was 30.1% in the switching group and 51.6% in the add-on group. More patients in 
the add-on group had decreased dry eye levels than those in the switching group
(P < 0.0001).
CONCLUSIONS: CBLAT improves ocular surface staining grades, tBUT, Schirmer I
values, and ocular symptoms in patients with dry eye syndrome.

PMID: 26509769   [PubMed - as supplied by publisher]


26. Cornea. 2015 Oct 27. [Epub ahead of print]

Corneal Collagen Cross-Linking for Infectious Keratitis: A Systematic Review and 
Meta-Analysis.

Papaioannou L(1), Miligkos M, Papathanassiou M.

Author information: 
(1)*Cornea Clinic, 2nd Ophthalmology Department, Attikon University Hospital,
Athens, Greece; and †Laboratory of Biomathematics, University of Thessaly School 
of Medicine, Larissa, Greece.

PURPOSE: To assess the efficacy of corneal collagen cross-linking (CXL) in the
management of infectious keratitis.
METHODS: Comprehensive literature search was performed in MEDLINE/PubMed and
Cochrane Central Register of Controlled Trials using combinations of the
following search terms: "corneal collagen cross linking" or "photoactivated
riboflavin" or "UVA light and riboflavin" and "infectious keratitis" or "corneal 
ulcer." Last search was on March 19, 2015. Extracted data from individual studies
were summarized and summary proportions of eyes healed and complications for
different subgroups were estimated.
RESULTS: Twenty-five studies were included (2 randomized controlled trials, 13
case series, and 10 case reports) with a total of 210 eyes of 209 patients, of
which 175 eyes underwent CXL. Causative microorganisms were bacteria, fungi,
acanthamoeba, and Herpes simplex virus in 96, 32, 11, and 2 cases, respectively. 
Coinfections were present in 13 and cause was inconclusive in 21 cases. Sixteen
of 175 eyes received no additional antibiotics, whereas 159 underwent CXL as an
adjunct to antimicrobial treatment. Proportion of eyes healed with CXL was 87.2% 
(95% confidence interval (CI), 81.9%, 91.8%). For bacterial keratitis, the
proportion of eyes healed was 85.7% (95% CI, 78.5%, 91.7%), whereas 10/11 and
25/32 eyes with acanthamoeba and fungal keratitis, respectively, were healed
(available data not sufficient to provide a valid proportion analysis). Treatment
resulted in corneal melting and tectonic keratoplasty in both Herpes simplex
virus cases.
CONCLUSIONS: CXL seems promising in the management of infectious keratitis,
excluding viral infections. However, more randomized controlled trials are
required to assess its efficacy.

PMID: 26509768   [PubMed - as supplied by publisher]


27. Cornea. 2015 Oct 27. [Epub ahead of print]

Association Between Keratoconus and Familial Mediterranean Fever in Turkey.

Kosker M(1), Arslan N, Alp MY, Ozisler C, Acar M, Dogan AS, Yesilyurt A, Gurdal
C.

Author information: 
(1)*Cornea Service, Department of Ophthalmology, Diskapi Yildirim Beyazit
Training and Research Hospital, Ankara, Turkey; †Genetic Diagnostic Center,
Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; and
‡Department of Rheumatology, Diskapi Yildirim Beyazit Training and Research
Hospital, Ankara, Turkey.

PURPOSE: To evaluate the association between familial Mediterranean fever (FMF)
and keratoconus (KC).
METHODS: This retrospective case-control study was performed to compare the
prevalence of KC in patients with FMF with the corresponding prevalence in
control patients without FMF referred to Genetic Diagnostic Center at Diskapi
Yildirim Beyazit Training and Research Hospital from June 2012 to June 2015. We
included all 100 patients with FMF. Each FMF-affected patient was matched to 3
controls.
RESULTS: None of the patients in the control group (0%, 0/300) had KC, whereas 4 
of 100 patients with FMF (4%) had KC (P < 0.004). Three of 33 patients with a
homozygous mutation (9.1%) (M694V/M694V in 2 cases and M680I/M680I in 1 case) and
1 of the 46 patients with a compound heterozygous mutation (2.2%) (M694V/M680I)
had KC, whereas none of the 21 patients with a heterozygous mutation (0%) had KC.
All patients with KC were women, and mean age was 40.8 years (range, 30-51).
Although 1 of the 4 patients with KC had hypertension and type 2 diabetes
mellitus, the other 3 patients did not have any systemic illness except FMF. When
we compared the prevalence of KC in patients with FMF (4%) with the highest
prevalence of KC reported in the literature (0.2%), FMF was a predisposing factor
to develop KC [odds ratio: 18.1 (95% CI: 11.9-27.5)] especially in patients with 
a homozygous mutation [odds ratio: 43.4 (95% CI: 28.6-65.7)].
CONCLUSIONS: Mediterranean fever (MEFV) gene mutations, particularly in
homozygous mutations of the MEFV gene, may be a predisposing factor in the
development of KC.

PMID: 26509767   [PubMed - as supplied by publisher]


28. Cornea. 2015 Dec;34(12):1606-10. doi: 10.1097/ICO.0000000000000661.

Real-Time Microscope-Integrated OCT to Improve Visualization in DSAEK for
Advanced Bullous Keratopathy.

Pasricha ND(1), Shieh C, Carrasco-Zevallos OM, Keller B, Izatt JA, Toth CA, Kuo
AN.

Author information: 
(1)*Department of Ophthalmology, Duke University School of Medicine, Durham, NC; 
and †Department of Biomedical Engineering, Duke University, Durham, NC.

PURPOSE: To report the intraoperative use of microscope-integrated optical
coherence tomography (MIOCT) to enable visualization for Descemet's stripping
automated endothelial keratoplasty (DSAEK) in 2 patients with advanced bullous
keratopathy.
METHODS: Patient 1 was an 83-year-old female and patient 2 was a 28-year-old male
both with limited vision and significant pain from bullous keratopathy who
underwent palliative DSAEK. Because of the severity and chronicity of the corneal
decompensation in both patients, the view past the anterior cornea was negligible
using standard microscope illumination techniques. We used spectral-domain
(Patient 1) and swept-source (Patient 2) MIOCT, both of which rely on infrared
illumination, to visualize key parts of the DSAEK procedure.
RESULTS: Graft insertion, unfolding, tamponade, and attachment could be
dynamically visualized intraoperatively despite the nearly opaque nature of the
host corneas. Postoperatively, the grafts remained attached with significant
corneal clearing, and there was improvement in visual acuity, and pain relief for
both patients.
CONCLUSIONS: MIOCT is a valuable tool for the corneal surgeon, allowing for DSAEK
to be successfully performed even when the surgical microscope view is limited
from severe corneal edema, as is often the case in patients with advanced bullous
keratopathy. By using MIOCT, these patients can benefit from the advantages of
DSAEK despite a clinically opaque cornea, which would otherwise be treated with a
penetrating keratoplasty.

PMCID: PMC4636956 [Available on 2016-12-01]
PMID: 26509766   [PubMed - in process]


29. Cornea. 2015 Oct 27. [Epub ahead of print]

Comparison of a Supraglottic Gel Device and an Endotracheal Tube in Keratoplasty 
Performed Under General Anesthesia: A Randomized Clinical Trial.

Guerrier G(1), Boutboul D, Rondet S, Hallal D, Levy J, Sjögren L, Legeais JM,
Nicolau R, Mehanna C, Bourges JL, Samama CM.

Author information: 
(1)*Service d'Anesthésie-Réanimation, Hôpital Cochin, Assistance
Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France; and
†Service d'Ophtalmologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 
Université Paris Descartes, Paris, France.

PURPOSE: To assess the safety of a laryngeal mask (i-gel) in keratoplasty
performed under general anesthesia.
METHODS: Patients with indications for keratoplasty (n = 110) were enrolled in a 
prospective study and randomly assigned to the i-gel (n = 55; 30 lamellar
keratoplasty and 25 penetrating keratoplasty) or tracheal tube group (n = 55; 29 
lamellar keratoplasty and 26 penetrating keratoplasty). Perioperative
complications and the recovery time were compared between the 2 groups using the 
t test or χ test. Contraindications to elective use of the laryngeal mask airway 
(esophageal reflux, extreme obesity, oropharyngeal pathology, or expected
difficult intubation) and expected difficult intubation were excluded.
RESULTS: No surgical perioperative complications were reported in either group.
There was a significantly greater incidence of coughing at extubation and/or
after extubation in the tracheal group (40/55; 73%) than in the laryngeal mask
group (3/55; 5%) (P < 0.001). The recovery time was shorter in the i-gel group
(80 minutes; 95% confidence interval, 75-86) compared with that in the tracheal
tube group (88 minutes; 95% confidence interval, 82-95) (P = 0.03). There were no
significant differences in the incidence of sore throat and hoarseness between
both devices.
CONCLUSIONS: The use of i-gel for keratoplasty under general anesthesia appears
to be safe, reduces the risk of potential ocular hypertension during recovery,
and saves recovery time.

PMID: 26509765   [PubMed - as supplied by publisher]


30. Cornea. 2015 Oct 27. [Epub ahead of print]

Assessment of a Novel Corneal-Shaping Device With Simultaneous Corneal Collagen
Cross-Linking Using a Porcine Eye Model.

Zhu AY(1), Vianna LM, Borkenstein EM, Elisseeff J, Jun AS.

Author information: 
(1)*Case Western Reserve University School of Medicine, Cleveland, OH; †Wilmer
Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD; ‡Borkenstein & 
Borkenstein, Fachaerzte fuer Augenheilkunde, Graz, Austria; and §Translational
Tissue Engineering Center, Johns Hopkins Medical Institutions, Baltimore, MD.

PURPOSE: Corneal collagen cross-linking (CXL) alone cannot substantially improve 
refractive errors. We designed a novel corneal-shaping device, showing that a
prototype applied during CXL can alter corneal curvature to a greater extent than
CXL alone in a porcine eye model.
METHODS: The device prototype was made with flat, UV-transmissible material.
Enucleated porcine eyes were deepithelialized and perfused. Preexperimental and
postexperimental corneal curvature (K) measurements and Anterior Segment Optical 
Coherence Tomography imaging were performed. A conventional CXL protocol was
followed. Six experiments of 6 treatment groups in duplicate were performed (n = 
12/group): (A) no CXL + no device, (B) no CXL + 30 minutes device, (C) 10
minutes, CXL + no device, (D) 10 minutes, CXL + device, (E) 30 minutes, CXL + no 
device, and (F) 30 minutes, CXL + device.
RESULTS: There was a significant decrease (P < 0.001) in corneal curvature after 
30 minutes. CXL between group F (-1.54 ± 0.90 D) and groups E (+0.34 ± 0.53 D), B
(+0.69 ± 1.02 D), or A (+0.22 ± 1.24 D). The demarcation line depth was greater
in group F (34% ± 4%) than group D (30% ± 4%, P < 0.05). Groups D (-2.3% ± 21%)
and F (0.24% ± 15%) had less change in corneal thickness than in control groups A
(15% ± 12%, P < 0.05) and E (12% ± 11%, P < 0.05).
CONCLUSIONS: Application of our corneal-shaping device during CXL significantly
decreased corneal curvature compared with controls. Anterior Segment Optical
Coherence Tomography imaging showed comparable extent of cross-linking in eyes
treated ± device. This demonstrates that our novel device used during CXL may
further promote corneal strengthening and refractive correction in patients.

PMID: 26509764   [PubMed - as supplied by publisher]