26 research outputs found
A prospective trial of postoperative Lodoxamide (Alomide) on pterygium recurrence
Background: To compare pterygium recurrence after bare sclera excision with and without topical lodoxamide.Design: Randomised double-blind study.Methods: The study involved 61 patients with primary pterygia who had bare sclera excision after informed consent. They were post-operatively treated by either of 2 treatment groups for 4 weeks, with a 30-months follow-up: Controls/placebo = Guttae prednisolone 1% with chloramphenicol 0.5% plus guttae distilled water. Test group = Guttae prednisolone 1% with chloramphenicol 0.5% plus guttae lodoxamide 0.1%.Results: Sixty patients were analysed. Control Group had 20 females and 10 males, aged 28-69.5 years, mean 42.0(± 10.9). Test Group had 15 males and 15 females, aged 17-75 years, mean 46.0(±12.6). Recurrence for the Test Group was 11(37%) within 30 months and 11(37%) for the Control Group within 30 months (OR=1.00, CI: 0.35-2.858). Main complications encountered were granuloma: 7(11.7%) from the controls and 5(8.3%) from the test group; restriction in the motility of medial rectus muscle: 1(1.7%) from each group; persistent vascularisation at site of excision: 1(1.7%) from each group and adherence leukoma with uveitis 1(1.7%) from the control group, the latter also had persistent peripheral corneal epithelial defect later resulting in a dellen. No significant difference was found between the treatment groups with respect to recurrence, type and time of complications, orientation and morphology of pterygium, P>0.05.Conclusion: The recurrence of pterygium is high (about one third) with or without the use of adjuvant lodoxamide.Keywords: Pterygium, epidemiology, bare sclera, Lodoxamide (Alomide), recurrence
Epidemiology and recurrence rate of pterygium post excision in Ghanaians
Objectives: To determine the epidemiology and recurrence rate of pterygium after excision using bare sclera techniqueDesign: Prospective non-comparative study.Setting: Ophthalmology unit, Korle-Bu Teaching Hospital, Accra, Ghana.Methods: The study involved 60 consecutive patients with primary apterygial from July 1998 to December 2000 who had bare sclera excision after informed consent. They were post-operatively followed up for 30-months.Results: Thirty-five patients (58%) were females. The patients' ages ranged from 17-75 years, mean (±12.6). Overall recurrence was 22(37%). The main complications encountered include were granuloma 20 %( n=12), restriction in medial rectus muscle motility 2(3%), persistent vascularisation at excision site 2(3%) and adherence leucoma with uveitis 1(2%). No significant association was found between recurrence and pterygium morphology, calcification, allergy and occupation (indoor or outdoor).Conclusion: The recurrence rate after pterygium excision using bare sclera technique in Ghanaians is high (37%).Keywords: Pterygium, epidemiology, bare sclera excision, recurrence, conjunctival growth
Is Microsporidial keratitis an emerging cause of stromal keratitis? – a case series study
BACKGROUND: Microsporidial keratitis is a rare cause of stromal keratitis. We present a series of five cases of microsporidial keratitis from a single centre in southern India with microbiologic and histopathologic features. CASE PRESENTATION: Patient charts of five cases of microsporidial stromal keratitis diagnosed between January 2002 and June 2004 were reviewed retrospectively for clinical data, microbiologic and histopathologic data. The presence of microsporidia was confirmed by special stains on corneal scrapings and/or corneal tissues, and electron microscopy. All patients were immunocompetent with a preceding history of trauma in three. Four patients presented with unilateral, small, persisting deep stromal infiltrates, of uncertain etiology, in the cornea, which were not responding to conventional antimicrobial treatment and required penetrating keratoplasty in three. Fifth case was unsuspected and underwent keratoplasty for post-traumatic scar. Three of five cases were diagnosed on corneal scrapings, prior to keratoplasty, while two were diagnosed only on histology. The microsporidia appeared as oval well defined bodies with dense staining at one pole. None of the patients showed recurrence following keratoplasty. CONCLUSION: Microsporidia, though rare, should be suspected in chronic culture-negative stromal keratitis. Organisms could lie dormant without associated inflammation
Keratocyte loss in corneal infection through apoptosis: a histologic study of 59 cases
BACKGROUND: Keratocyte loss by apoptosis following epithelial debridement is a well-recognized entity. In a study of corneal buttons obtained from patients of corneal ulcer undergoing therapeutic keratoplasty, we observed loss of keratocytes in the normal appearing corneal stroma, surrounding the zone of inflammation. Based on these observations, we hypothesized that the cell loss in the inflammatory free zone of corneal stroma is by apoptosis that could possibly be a non-specific host response, independent of the nature of infectious agent. METHODS: To test our hypothesis, in this study, we performed Terminal deoxyribonucleotidyl transferase-mediated d-Uridine 5" triphosphate Nick End Labelling (TUNEL) staining on 59 corneal buttons from patients diagnosed as bacterial, fungal, viral and Acanthamoeba keratitis. The corneal sections were reviewed for morphologic changes in the epithelium, stroma, type, degree and depth of inflammation, loss of keratocytes in the surrounding stroma (posterior or peripheral). TUNEL positivity was evaluated in the corneal sections, both in the zone of inflammation as well as the surrounding stroma. A correlation was attempted between the keratocyte loss, histologic, microbiologic and clinical features. RESULTS: The corneal tissues were from 59 patients aged between 16 years and 85 years (mean 46 years) and included fungal (22), viral (15), bacterial (14) and Acanthamoeba (8) keratitis. The morphological changes in corneal tissues noted were: epithelial ulceration (52, 88.1%), destruction of Bowman's layer (58, 99%), mild to moderate (28; 47.5%) to severe inflammation (31; 52.5%). Morphologic evidence of disappearance or reduced number of keratocytic nuclei in the corneal stroma was noted in 49 (83%) cases; while the TUNEL positive brown cells were identified in all cases 53/54 (98%), including cases of fungal (19), bacterial (14), viral (13), and Acanthamoeba keratitis. TUNEL staining was located mostly in the deeper stroma and in few cases the peripheral stroma. TUNEL positivity was also noted with the polymorphonuclear infiltrates and in few epithelial cells (10 of 59, 17%) cases, more with viral infections (6/10; 60%). CONCLUSIONS: We report apoptotic cell death of keratocytes in the corneal stroma in infectious keratitis, a phenomenon independent of type of infectious agent. The inflammatory cells in the zone of inflammation also show evidence of apoptotic cell death. It could be speculated that the infective process possibly triggers keratocyte loss of the surrounding stroma by apoptosis, which could possibly be a protective phenomenon. It also suggests that necrotic cell death and apoptotic cell deaths could occur simultaneously in infective conditions of the cornea
Changing trends in ocular cysticercosis over two decades: An analysis of 118 surgically excised cysts
Purpose : To evaluate the frequency of ocular cysticercosis and to
demonstrate the changing trends in localisation of ocular cysticercosis
along with a brief review of literature. Methods : A retrospective
analysis of histology proven ocular cysticercosis cases seen over a
period of 20 years (1981 through 2000) was done. The pathology record
forms were reviewed for demographics, clinical features with specific
reference to the location of cysts in four subgroups: subconjunctival;
intraocular orbit and eyelid. The distribution of cases in four
five-year periods namely group A: 1981-1985, group B: 1986-1990, group
C: 1991-1995 and group D: 1996-2000 and the changing trends in the
location of cysts was evaluated. Results : One hundred eighteen cysts
from 118 patients aged 4-72 (mean 17.1) years were submitted to the
pathology service of S D Eye Hospital, Hyderabad. Male to female ratio
was 1: 1.2. Total number of cases in groups A, B, C and D were 33, 41,
16 and 25 respectively. Location of cysts was subconjunctival - 74
(62.7%); intraocular-31 (26.3%); orbital-8 (7%) and lid-5 (4%). In last
20 years, significant decrease ( P =0.0001) was noted in
subconjunctival cases (85% vs. 28%) with a significant rise ( P
=0.0001) in intraocular cysticercosis (6% vs. 60%). Conclusions :
Frequency of surgically excised ocular cysticercosis remained constant
over last two decades with an increasing manifestation of intravitreal
cysticercosis in the recent years. This could imply either improved
diagnostic modalities, available expertise in vitreo-retinal surgery or
ineffective medical treatment for intraocular parasitic infection. The
relative decrease in extraocular cysticercosis is probably due to the
increased preference and success with medical management
Technique of cultivating limbal derived corneal epithelium on human amniotic membrane for clinical transplantation
Background : The technique of transplantation of cultivated limbal
epithelium rather than direct limbal tissue isa novel method of "cell
therapy" involved in reconstructing the ocular surface in severe limbal
stem celldeficiency [LSCD], caused by chemical burns. Aim : To describe
a simple feeder-cell free technique of cultivating limbal epithelium on
human amniotic membrane[HAM]. Materials and Methods : The limbal
tissues (2 mm) were harvested from patients with LSCD. These
tissueswere proliferated in vitro on HAM supplemented by human corneal
epithelial cell medium and autologousserum. Cultures covering more
6550% area of 2.5x5 cm HAM were considered adequate for clinical
use. Thecultured epithelium was characterized by histopathology and
immunophenotyping.Results: A total of 542 cultures out of 250 limbal
tissues were cultivated in the laboratory from January 2001through July
2005. The culture explants showed that clusters of cells emerging from
the edge of the explantsin one-three days formed a complete monolayer
within 10-14 days. In 86% of cultures (464 of 542), thegrowth was
observed within one-two days. Successful explant cultures were observed
in 98.5% (534 of 542cultures) with 91% explant cultures showing an area
of 656.25 cm2 (6.25 - 12.5 cm2 range). The cultivatedepithelium
was terminated between 10-14 days for clinical transplantation. The
problems encountered wereinadequate growth (2 of 542) and contamination
(2 of 542). Conclusions : We demonstrate a simple technique of
generating a sheet of corneal epithelium from a limbalbiopsy. This new
technique could pave the way for a novel form of cell therapy