Bruce H. Koffler

Corneal allograft rejection following immunization

Five patients developed corneal allograft rejection after immunization. One patient, a 33-year-old woman, received a tetanus toxoid booster nine months after a corneal transplant for keratoconus. Within four days she developed a graft rejection that required a penetrating keratoplasty two years later. Six months later, after hepatitis B immunization, the patient reported decreased vision and the graft was cloudy, but visual acuity was 20/20. The other four patients developed graft rejection after influenza immunization. Two of these four graft rejection episodes were successfully treated with high-dose corticosteroid therapy; all episodes occurred within several weeks of influenza immunization. Patients should be prudently counseled regarding the possible risks of immunization to corneal allograft survival.

Extending the Duration of Tear Film Protection in Dry Eye Syndrome: Review and Retrospective Case Series Study of the Hydroxypropyl Cellulose Ophthalmic Insert

Options for extending the duration of tear film protection in dry eyes include artificial tear formulations with enhanced viscosity/polymeric systems, ocular ointments and gels, and, recently, the hydroxypropyl cellulose ophthalmic insert (Lacrisert(R); distributed by Aton Pharma, Inc., Lawrenceville, NJ, USA). The goal in using these agents is to achieve a balance between maximizing tear film stability and ocular surface retention, while simultaneously maintaining or improving vision, comfort, and convenience. In this article, various agents are reviewed, and findings are presented from a retrospective study of patients who used hydroxypropyl cellulose ophthalmic inserts within the previous 2 years. The median length of therapy with the insert was 5.3 years, and nearly 65% of patients had used it for more than 2 years. Findings suggest that the hydroxypropyl cellulose ophthalmic insert is a relatively safe, tolerable, and effective therapy for dry eye, either alone or in conjunction with other therapies.

Autologous serum Therapy of the ocular surface with Novel Delivery by Platelet Concentrate Gel

Application of autologous serum to treat a multitude of ocular surface diseases and conditions is a relatively new technique that has gained popularity over the past 10 years. This review focuses on the use of topical autologous serum and a new platelet gel delivery technique that utilizes autologous platelet concentrate mixed with calcium chloride and thrombin for gelling serum, which can then be applied easily to the corneal surface. Residual platelet serum concentrate can be mixed with artificial tears that are capable of gelling in a 25% concentrate, which is then used by the patient postoperatively. A review of the literature identifies various concentrations of autologous serum, frequency of application, and storage criteria.

Question and Answer Sessions with Prof. Eberhart Zrenner

Chairman: Prof. Dr. Makoto Tamai (Department of Ophthalmology, Tohoku University School of Medicine) Dr. Tamai: Thank you for your very informative lecture. I remember seeing a picture of the round chip, prototype 1, in the Medical Tribune. It was reported to have excellent biocompatibility. Later, I had opportunities to hear about studies in this field from time to time. Today, I was surprised to learn that development has progressed to a point where studies on passive and active implants will be actually conducted in humans. Many in the audience, I believe, were also amazed by this progress. Our eyes are important sensory organs. The possibility of recovering vision, even partly, is wonderful news for patients. I shared with the audience the excitement of this possibility. While questions are invited from the audience, let me ask the first question. Dr. Zrenner, after working so much in this field, how many patents have you accumulated? Dr. Zrenner: We have six patents, in the meantime, for various things like the subretinal delivery, anatomical positioning, characteristics of subretinal prosthesis and its production method. Dr. Tamai: What is your annual study budget? Dr. Zrenner: We have two groups in Germany, the North German group for epiretinal implants and the South German group for subretinal implants. The German government invested 10 million dollars from 1995 to 1999 and 6 million dollars from 1999 to date. So, the total is roughly 16 million dollars for both groups. Dr. Tamai: Ten million dollars, or roughly 1 billion yen, in the first 3 years and 6 million dollars for the next project term do not seem to be an exceptionally large budget. As you mentioned, Japan has launched a retinal prosthesis project, which is being conducted by NIDEK Co., Ltd. and New Energy and Industrial Technology Development Organization (NEDO) under the Ministry of Economy, Trade and Industry. Because a substantial budget is going to be available, I expect to see the fruits of this project in the near future. Dr. Miyake at Nagoya University and Dr. Yagi at the School of Engineering, Nagoya University are working with NIDEK. I hope that work in this field will also progress in Japan. Thank you.