Risk Factors for Senile Corneal Arcus in Patients with Acute Myocardial Infarction

Purpose: To investigate the association between senile corneal arcus and atherosclerosis risk factors in patients with recent acute myocardial infarction. Methods: In this cross sectional study, atherosclerosis risk factors including fasting blood sugar, total cholesterol and triglyceride levels were measured in 165 patients with recent (less than three months′ duration) acute myocardial infarction. Slitlamp examination was performed to detect corneal arcus. Associations between senile corneal arcus and atherosclerosis risk factors were assessed. Results: Overall, 165 patients including 100 male and 65 female subjects with mean age of 62±10.3 years were evaluated. In 122 patients (74%), variable degrees of corneal arcus were observed. The presence of corneal arcus was significantly associated with age (P = 0.03) and high levels of total cholesterol (over 200 mg/dl, P < 0.01). After adjusting for age, arcus was not associated with sex (P = 0.10), hypertriglyceridemia (P = 0.09), fasting blood sugar (P = 0.06), or systemic hypertension (P = 0.08). Conclusion: Our study revealed that corneal arcus is associated with age and hypercholesterolemia in patients with recent acute myocardial infarction. No association was detected with sex, fasting blood sugar, hypertension, and hypertriglyceridemia

Bilateral Terrien’s Marginal Degeneration and Posterior Polymorphous Dystrophy in a Patient with Rheumatoid Arthritis

Purpose: To report an interesting case of concomitant bilateral Terrien′s marginal degeneration-like corneal ectasia and posterior polymorphous corneal dystrophy in a young man with quiescent rheumatoid arthritis. Case Report: A 24-year-old man with history of rheumatoid arthritis presented with bilateral decreased vision since four years ago. Slit lamp examination revealed bilateral circumferential peripheral corneal thinning and bulging with vascularization and lipid deposition in addition to band-like lesions in descemet′s membrane. Previous records revealed no gross corneal abnormalities up to 4 years ago. Corneal lesions were compatible with bilateral circumferential Terrien′s marginal degeneration concomitant with posterior polymorphous dystrophy. Conclusion: To our knowledge, this is the first report of concomitant bilateral Terrien′s marginal degeneration with peripheral corneal ectasia and posterior polymorphous dystrophy in a patient with rheumatoid arthritis. Bilateral circumferential involvement, younger age at presentation and total peripheral corneal ectasia as observed in this case are not typical for classic Terrien′s marginal degeneration

Chitosan-coated contact lens-based ophthalmic drug delivery system to manage Acanthamoeba keratitis: A preliminary hypothesis

Background:&nbsp;Acanthamoeba species can cause devastating contact lens (CL)-related microbial keratitis. Its culture is less sensitive, and little evidence is available for the safety or efficacy profile of medications. Therefore, early diagnosis and optimal treatment remain difficult. The aim of this study was to present the hypothesis that a novel chitosan-coated CL-based ophthalmic drug delivery system has therapeutic and prophylactic effects on acanthamoeba keratitis. Hypothesis:&nbsp;CL-based drug delivery is a popular sustained-release drug delivery that extends the drug release time, thus increasing its bioavailability and treatment efficacy. Chitosan, a derivative of chitin, has antioxidant and broad-spectrum antimicrobial properties against fungi, yeasts, and bacteria. It acts against microbial cells; however, whether its mechanism of action is microbiostatic or microbicidal remains unknown. It exhibits wound healing and film-forming properties. Chitosan composite films permit high transmittance of visible light, making it transparent and therefore desirable for the development of CLs. Chitosan/Ag/ZnO blend films exhibit antimicrobial activities. Further, soft CLs coated with chitosan, sodium hyaluronate, polylysine hydrobromide, and sodium alginate show drug delivery properties and reduced bacterial growth. Recently, concentration-dependent anti-amoebic activities of chitosan and nano-chitosan against the trophozoite and cystic forms of Acanthamoeba have been reported. Based on the existing evidence, we hypothesized that a chitosan-coated CL-based ophthalmic drug delivery system could have therapeutic and prophylactic effects on acanthamoeba keratitis or subsequent endophthalmitis. Conclusions:&nbsp; CLs or intraocular implants with chitosan-based nanocoatings alone or in combination with routine treatment may be preventive or therapeutic for acanthamoeba keratitis or endophthalmitis. Experimental studies and further clinical trials are required to explore the efficacy and safety profile. Moreover, randomized controlled trials in healthy eyes with soft or hard CLs or orthokeratology lenses for refractive error correction may shed light on the prophylactic effect of this novel drug delivery system. Other forms of ophthalmic drug delivery systems using chitosan-based nanocoatings should be studied additionally

Keratin 13 is a more specific marker of conjunctival epithelium than keratin 19

PurposeTo evaluate the expression patterns of cytokeratin (K) 12, 13, and 19 in normal epithelium of the human ocular surface to determine whether K13 could be used as a marker for conjunctival epithelium.MethodsTotal RNA was isolated from the human conjunctiva and central cornea. Those transcripts that had threefolds or higher expression levels in the conjunctiva than the cornea were identified using microarray technique. Expression levels of three known signature genes and of two conjunctival genes, K13 and K19 were confirmed by using quantitative real-time PCR (qRT-PCR). Protein expression of K12, K13, and K19 was confirmed by immunostaining with specific antibodies on histologic sections of human sclerocornea that contained the conjunctiva, limbus, and cornea and on impression cytology (IC) specimens of the cornea and conjunctiva from normal donors. Double staining of K13/K12 and K19/K12 on histologic sections and IC specimens was performed.ResultsThere were 337 transcripts that were preferentially expressed in the conjunctiva. K13 and K19 were among the top twenty transcripts in the conjunctiva and this preferential expression pattern of K13 and K19 was confirmed by qRT-PCR. Immunohistochemical studies showed that K13 was expressed at the posterior limbal epithelium and conjunctival epithelium but was totally absent in the cornea. K12 was expressed in the corneal and anterior limbal epithelia except for the basal layer and was absent from the conjunctiva. In contrast, K19 was detected in the corneal, limbal and conjunctival epithelia. Immunostaining of the IC specimens showed K12(+) epithelial cells in the corneal region, K13(+) cells in the conjunctival area, and K19(+) cells in the corneal and conjunctival specimens. Expression of K13 and K12 on the ocular surface was mutually exclusive on both the histologic and IC samples using double immunostaining.ConclusionsK13 is more specific to the conjunctival epithelial cells than K19 and potentially could be used as a marker to identify conjunctival epithelial cells in limbal stem cell deficiency

The Effect of Cycloplegia on the Ocular Biometric and Anterior Segment Parameters: A Cross-Sectional Study

INTRODUCTION: To evaluate the effects of cycloplegia on the biometric components and anterior segment parameters of the eye. METHODS: In this cross-sectional study, changes to axial length (AL), anterior chamber depth (ACD) lens thickness, anterior chamber angle (ACA) and volume, corneal thickness in the pupil center (PC), corneal curvature (CC) and white-to-white (WTW) following cycloplegia induced by tropicamide 1% in 42 eyes of patients aged 23-58 years were assessed. Biometric components and anterior segment parameters were measured using an IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany) and a Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany), respectively. RESULTS: Significant statistical changes in ACD (increased by 0.06 ± 0.05 mm; p  0.05). Also, a significant inferior displacement of the PC along the vertical axes was seen (p = 0.020). CONCLUSION: Cycloplegia resulted in a deeper ACD and thinner lens thickness. These changes should be considered in determining intraocular lens (IOL) power to prevent refractive surprises in cataract surgery and also in the phakic IOL implantation

Indications for Corneal Transplantation at a Tertiary Referral Center in Tehran

Purpose: To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period. Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. Results: During this period, 776 eyes of 756 patients (including 504 male subjects) with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8%) followed by bullous keratopathy (n=90, 11.6%), non-herpetic corneal scars (n=62, 8.0%), infectious corneal ulcers (n=61, 7.9%), previously failed grafts (n=61, 7.9%), endothelial and stromal corneal dystrophies (n=28, 3.6%), and trachoma keratopathy (n=26, 3.3%). Other indications including Terrien′s marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty (n=607, 78.2%), deep anterior lamellar keratoplasty (n=108, 13.9%), conventional lamellar keratoplasty (n=44, 5.7%), automated lamellar therapeutic keratoplasty (n=8, 1.0%), and Descemet stripping endothelial keratoplasty (n=6, 0.8%) in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty. Conclusion: In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium

Masked comparison of two silicone hydrogel bandage contact lenses after photorefractive keratectomy

Purpose: To compare the efficiency and safety of two bandage contact lenses after photorefractive keratectomy (PRK). Methods: In this double-blind study, 45 patients (90 eyes) received PRK in both eyes and wore bandage contact lenses (BCLs), PureVision (Bausch & Lomb, Rochester, NY, USA) in one eye and PureVision2 (Bausch & Lomb, Rochester, NY, USA) in the other eye, randomly assigned. The medication regimen after surgery was the same for both eyes. The epithelial defect's size, conjunctival hyperemia and lens centration were graded objectively using slit-lamp biomicroscopy on days 1, 3 and 5 after surgery. Also ocular symptoms of discomfort including tearing, photophobia, foreign body sensation and visual fluctuations were assessed subjectively at each visit. Results: The mean epithelial defect size on the first day after operation was similar in eyes fitted with PureVision (30.08 ± 5.30 mm²) and PureVision2 (30.25 ± 5.72 mm2) lenses. (p = 0.79) Contact lens deposits and bulbar hyperaemia on days 1 and 3 after PRK were similar between the two eyes, but were significantly greater on day 5 for PureVision2 lenses. (p = 0.02; p = 0.04 respectively) There was no difference in contact lens decentration, and discomfort symptoms including pain, tearing, foreign body sensation, photophobia and visual fluctuations between the eyes fitted with PureVision and PureVision2. (p > 0.05) Conclusions: PureVision and PureVision2 contact lenses are equivalent as bandage lenses in important aspects such as corneal re-epithelialization and subjective comfort., although PureVision2 led to a higher incidence of contact lens deposits and conjunctival hyperemia early post-PRK

A Technique to Salvage Big-Bubble Deep Anterior Lamellar Keratoplasty after Inadvertent Full-Thickness Trephination

Herein we describe a technique for management of large inadvertent full-thickness trephination during deep anterior lamellar keratoplasty using the big-bubble technique without converting to penetrating keratoplasty. First, the anterior chamber is formed with an ophthalmic viscosurgical device (OVD). Then, the full-thickness wound is secured with one X-type 10-0 nylon suture. A 27-gauge needle is attached to a 2 ml air-filled syringe and inserted into the corneal stroma in the meridian opposite to the site of full-thickness trephination. Air is gently injected to produce a limited area of "big-bubble" detaching Descemet′s membrane (DM) from the corneal stroma. The "big bubble" is slowly expanded with injection of OVD. Finally, the recipient stroma is removed, the donor lenticule is placed and the DM tear is secured with one full thickness 10-0 nylon suture

Hydrophilic acrylic intraocular lens opacification after descemet stripping automated endothelial keratoplasty

Purpose: To report hydrophilic acylic intraocular lens (IOL) opacification after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in an eye with multiple prior intraocular surgeries and iatrogenic aniridia. Case Report: A 34-year-old woman with history of penetrating keratoplasty (PKP) for advanced keratoconus and subsequent Urrets-Zavalia Syndrome (UZS) underwent phacoemulsification and hydrophilic acrylic IOL implantation for her cataract. In order to control post-PKP glaucoma, multiple glaucoma surgeries including two glaucoma drainage implants were performed. As the original corneal graft failed, the patient subsequently underwent re-PKP. Four years later, she underwent DSAEK for treatment of the second graft failure. Ten months after DSAEK, a double semi-circular pattern of IOL opacification was observed on the anterior surface of the IOL. The patient did not report any complaints and we decided not to exchange the IOL. Conclusion: In an eye with UZS and iatrogenic aniridia, IOL opacification may result from direct contact between the IOL surface and exogenous air. Aniridia can be a risk factor for development of IOL opacification after DSAEK. Further studies are required to confirm this hypothesis

Cataracts in Diabetic Patients: A Review Article

&lt;!--[if gte mso 9]&gt;&lt;xml&gt; Normal 0 false false false MicrosoftInternetExplorer4 &lt;/xml&gt;&lt;![endif]--&gt;&lt;!--[if gte mso 9]&gt;&lt;xml&gt; &lt;/xml&gt;&lt;![endif]--&gt; &lt;!--[if gte mso 10]&gt; &lt;style&gt;&#13; /* Style Definitions */&#13; table.MsoNormalTable&#13; {mso-style-name:"Table Normal";&#13; mso-tstyle-rowband-size:0;&#13; mso-tstyle-colband-size:0;&#13; mso-style-noshow:yes;&#13; mso-style-parent:"";&#13; mso-padding-alt:0cm 5.4pt 0cm 5.4pt;&#13; mso-para-margin:0cm;&#13; mso-para-margin-bottom:.0001pt;&#13; mso-pagination:widow-orphan;&#13; font-size:10.0pt;&#13; font-family:"Times New Roman";&#13; mso-ansi-language:#0400;&#13; mso-fareast-language:#0400;&#13; mso-bidi-language:#0400;}&#13; &lt;/style&gt; &lt;![endif]--&gt; &lt;p&gt;The number of people with diabetes mellitus is increasing and cataracts are one of the most common causes of visual impairment in these subjects. Advances in cataract surgical techniques and instrumentation have generally improved the outcomes; however, surgery may not be safe and effective in certain individuals with pre-existing retinal pathology or limited visual potential. This review article aims to address different aspects surrounding cataracts in diabetic patients. In a computerized MEDLINE search, relevant studies were selected by two authors using the keywords "diabetes mellitus", "cataract", "diabetic retinopathy" and "diabetic maculopathy".&lt;/p&gt; &lt;!--[if gte mso 9]&gt;&lt;xml&gt; &lt;o:OfficeDocumentSettings&gt; &lt;o:RelyOnVML /&gt; &lt;o:AllowPNG /&gt; &lt;/o:OfficeDocumentSettings&gt; &lt;/xml&gt;&lt;![endif]--&gt;&lt;!--[if gte mso 9]&gt;&lt;xml&gt; &lt;w:WordDocument&gt; &lt;w:View&gt;Normal&lt;/w:View&gt; &lt;w:Zoom&gt;0&lt;/w:Zoom&gt; &lt;w:PunctuationKerning /&gt; &lt;w:ValidateAgainstSchemas /&gt; &lt;w:SaveIfXMLInvalid&gt;false&lt;/w:SaveIfXMLInvalid&gt; &lt;w:IgnoreMixedContent&gt;false&lt;/w:IgnoreMixedContent&gt; &lt;w:AlwaysShowPlaceholderText&gt;false&lt;/w:AlwaysShowPlaceholderText&gt; &lt;w:Compatibility&gt; &lt;w:BreakWrappedTables /&gt; &lt;w:SnapToGridInCell /&gt; &lt;w:WrapTextWithPunct /&gt; &lt;w:UseAsianBreakRules /&gt; &lt;w:DontGrowAutofit /&gt; &lt;/w:Compatibility&gt; &lt;/w:WordDocument&gt; &lt;/xml&gt;&lt;![endif]--&gt;&lt;!--[if gte mso 9]&gt;&lt;xml&gt; &lt;w:LatentStyles DefLockedState="false" LatentStyleCount="156"&gt; &lt;/w:LatentStyles&gt; &lt;/xml&gt;&lt;![endif]--&gt; &lt;!-- /* Font Definitions */ @font-face {font-family:Palatino; mso-font-alt:"Book Antiqua"; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:7 0 0 0 147 0;} @font-face {font-family:Calibri; mso-font-alt:"Century Gothic"; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin-top:0cm; margin-right:0cm; margin-bottom:10.0pt; margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri; mso-fareast-font-family:Calibri; mso-bidi-font-family:Arial; color:windowtext;} p {mso-margin-top-alt:auto; margin-right:0cm; mso-margin-bottom-alt:auto; margin-left:0cm; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; color:black;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --&gt; &lt;!--[if gte mso 10]&gt; &lt;style&gt;&#13; /* Style Definitions */&#13; table.MsoNormalTable&#13; {mso-style-name:"Table Normal";&#13; mso-tstyle-rowband-size:0;&#13; mso-tstyle-colband-size:0;&#13; mso-style-noshow:yes;&#13; mso-style-parent:"";&#13; mso-padding-alt:0cm 5.4pt 0cm 5.4pt;&#13; mso-para-margin:0cm;&#13; mso-para-margin-bottom:.0001pt;&#13; mso-pagination:widow-orphan;&#13; font-size:10.0pt;&#13; font-family:"Times New Roman";&#13; mso-ansi-language:#0400;&#13; mso-fareast-language:#0400;&#13; mso-bidi-language:#0400;}&#13; &lt;/style&gt; &lt;![endif]--&gt