Ashlie Bernhisel

Vimentin knockdown decreases corneal opacity.

PURPOSE Wound induced corneal fibrosis can lead to permanent visual impairment. Keratocyte activation and differentiation play a key role in fibrosis, and vimentin, a major structural type III intermediate filament, is a required component of this process. The purpose of our study was to develop a nonviral therapeutic strategy for treating corneal fibrosis in which we targeted the knockdown of vimentin. METHODS To determine the duration of plasmid expression in corneal keratocytes, we injected a naked plasmid expressing green fluorescent protein (GFP; pCMV-GFP) into an unwounded mouse corneal stroma. We then injected pCMV-GFP or plasmids expressing small hairpin RNA in the corneal wound injury model (full-thickness corneal incision) to evaluate opacification. RESULTS GFP expression peaked between days 1 and 3 and had prominent expression for 15 days. In the corneal wound injury model, we found that the GFP-positive cells demonstrated extensive dendritic-like processes that extended to adjacent cells, whereas the vimentin knockdown model showed significantly reduced corneal opacity. CONCLUSIONS These findings suggest that a nonviral gene therapeutic approach has potential for treating corneal fibrosis and ultimately reducing scarring.

Intraoperative and postoperative pain in cataract surgery

Technologic improvements in cataract surgery have not only improved visual outcomes, but also have minimized intraoperative and postoperative pain. We review the mechanisms, risk factors, and management of intraoperative and postoperative pain. Summaries of less common sources of physiologic pain have been included to reinforce recognition of when pain represents an expected physiologic reaction to surgery as opposed to signaling a more serious complication. We also discuss various current and emerging anesthetic and analgesic modalities.

High vacuum and aspiration on phacoemulsification efficiency and chatter for Centurion

OBJECTIVE To compare relative efficiency and chatter of high aspiration and vacuum settings. DESIGN In vitro laboratory study. METHODS The John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, was the study setting. Porcine nuclei were fixed in formalin and cut into 2.0 mm cubes. Lens cubes were phacoemulsified with Balanced tips at 50 and 60 mL/min aspiration with 500, 600, and 700 mm Hg vacuum with monitored forced infusion. Experiments were conducted at constant torsional power, longitudinal power, and intraocular pressure. RESULTS No significant change was observed in average chatter across each tested setting. Increasing aspiration rate did not increase efficiency. Increasing vacuum up to 600 mm Hg from 500 mm Hg did not change efficiency. However, increasing vacuum to 700 mm Hg decreased efficiency (p = 0.008 for 500 mm Hg vs 700 mm Hg and p = 0.05 for 600 mm Hg vs 700 mm Hg). Increasing aspiration and increasing vacuum did not significantly improve chatter. CONCLUSIONS Increasing aspiration above 50 mL/min did not improve phacoemulsification efficiency. Increasing vacuum settings to 700 mm Hg decreases efficiency. Chatter did not significantly change with increasing aspiration and vacuum settings.

Subepidermal Calcinosis in the Ocular Adnexa: A Systematic Review

PURPOSE To review the clinical and histopathologic findings associated with subepidermal calcinosis of the eyelids. METHODS A systematic review of the literature on subepidermal calcinosis of the eyelids was performed. Cases included were idiopathic in nature and met the histologic criteria for subepidermal calcinosis with calcium deposits in the dermis of the skin. RESULTS Twenty-one publications presenting 53 cases of subepidermal calcinosis involving the eyelids were published between 1970 and 2016. Males were affected more than females (67% vs. 33%), and 89% of patients were 21 years of age or younger. A total of 63% were non-Caucasian. Most cases involved a single lesion (82%), and lesions were most frequently located on the upper eyelid (63%). In 81% of cases, the lesion was less than 5 mm in diameter. When reported, the treatment of choice was complete surgical excision. CONCLUSIONS Subepidermal calcinosis should be considered in the differential diagnosis of idiopathic lesions on the eyelid, particularly in young males with no history of systemic disease or laboratory abnormalities. These nodules usually present as painless, small, firm, mobile solitary cutaneous lesions with a predilection for the upper eyelid. Diagnosis is confirmed by histopathology, and treatment is with surgical excision.

Chronic undiagnosed orbital inflammation due to factitious disorder: a ‘think different’ paradigm

The Diagnostic and Statistical Manual V defines factitious disorder (previously Munchausen syndrome) as ‘falsification of physical or psychological signs or symptoms or induction of injury or disease, associated with identified deception’. Malingering is differentiated from factitious disorder by the intentional reporting of symptoms for personal gain, whereas factitious disorder requires the absence of physical reward, such as a compensation claim. Self-harm involving the eye can range from mild anterior segment disturbances to oedipism (self-enucleation). Such behaviour most commonly occurs in young males, particularly those who suffer from psychoses. One study found factitious disorder to comprise 0.8 per cent of referrals to psychiatry departments. We present a case of a young woman with a long history of undiagnosed inflammation affecting her left eye and orbit. Ophthalmologists attempted to treat her condition with multiple medical and surgical interventions. Her inconsistent behaviour led us to reconsider the cause of her unexplained condition. We describe briefly the five-year course of treatment for this clinical entity and what we have learned. CASE REPORT