Joel Sugar

Mitomycin C treatment for conjunctival-corneal intraepithelial neoplasia: a multicenter experience.

OBJECTIVE The purpose of the study is to evaluate the efficacy and risks of topical mitomycin C (MMC) for conjunctival-corneal intraepithelial neoplasia (CCIN). DESIGN The study design was a clinical case series of CCIN. PARTICIPANTS Seventeen patients, 16 with biopsy-confirmed CCIN and 1 with invasive squamous cell carcinoma (SCC), were included in the study. INTERVENTION Patients received topical drops of MMC 0.02% to 0.04% four times daily from 7 to 28 days. Retreatment was done in cases of lesion recurrence. MAIN OUTCOME MEASURES The size of the CCIN before and after the treatment and ocular complications post-MMC application were evaluated. RESULTS Ten patients remained disease-free after one course of MMC application. In one case, residual CCIN remained very small without regrowth. In the one patient with invasive SCC and in five patients with CCIN, regrowth occurred within 6 months of the first treatment. After retreatment, invasive SCC and CCIN in an additional two patients were eradicated. In two cases, although the size of the lesions decreased after two and three applications of MMC, regrowth occurred, and the CCIN returned to its original size. In the final case, limited recurrence has occurred and no retreatment has been done. The complications of MMC use included mild-to-moderate conjunctival hyperemia and mild allergy, which resolved after discontinuation of the treatment. Severe pain manifested when treatment was longer than 14 days. CONCLUSIONS Application of topical MMC is an efficient treatment for most but not all cases of CCIN.

An Ultrastructural and Histochemical Study of Long-Term Wound Healing after Radial Keratotomy

Using correlative microscopy and plant lectins conjugated to fluorescent dyes, we studied two human corneal specimens obtained 66 and 70 months after radial keratotomy. In one case a second radial keratotomy had been performed 11 months before we obtained the corneal specimen, which allowed us to compare wounds 11 and 66 months old in the same specimen. The 11-month-old incisions demonstrated morphologic features consistent with incomplete wound healing, whereas the incisions examined 66 and 70 months postoperatively demonstrated complete wound healing. A different lectin binding pattern of wheat germ agglutinin and concanavalin-A was observed in the 11-month-old wounds, compared with the 66-month-old wounds. Published and unpublished morphologic studies of 17 human keratotomy specimens have demonstrated incomplete wound healing up to 47 months postoperatively. The present study documents complete corneal wound healing 66 months after radial keratotomy.

Heterogeneity in keratoconus: possible biochemical basis.

Abstract Total protein and collagen content in normal and keratoconus corneas were determined. The protein content (expressed as a function of dry weight) in all keratoconus corneal samples was lower than that found in normal corneas. However, among the 11 keratoconus corneas examined, only 7 (group A) had the same hydroxyproline content (expressed as a function of dry weight) as normal corneas; 4 others (group B) showed significantly less. In tissue culture, four strains derived from keratoconus stroma (group I) produced total protein at the same rate as cells from normal controls. Four other strains (group II), however, had a decreased rate of protein synthesis. The amount of collagenous protein synthesized per microgram DNA by group I strains was similar to that found in normal cultures, whereas it was significantly reduced in group II cultures. We suggest that group I strains represent group A corneas. Group II strains, with a reduced level of both protein and collagen synthesis, may represent group B corneas. The defect in this group appears to be decreased total synthetic activity of corneal cells. The variation in our results suggests that keratoconus is a heterogeneous disease. The heterogeneity may explain the contradictory data that exist in the literature.

Primary Familial Amyloidosis of the Cornea

The stromal deposits of a failed corneal graft from a patient with primary familial amyloidosis of the cornea stained positively with Congo red and showed green birefringence with polarized light. These deposits contained protein AP but not protein AA, immunoglobulins, light chains, or prealbumin. The amyloid deposits of primary familial amyloidosis of the cornea differ from those in lattice corneal dystrophy which contain both protein AA and protein AP.

Assessment of visual function after corneal transplantation: the quality of life and psychometric assessment after corneal transplantation (Q-PACT) study

PURPOSE Many patients with successful corneal grafts have poor vision postoperatively. This study evaluates changes in vision-related quality of life after penetrating keratoplasty (PK). DESIGN Multicenter prospective cohort study. METHOD Penetrating keratoplasty candidates from the university-affiliated ophthalmology clinics of four participating centers were enrolled and followed up prospectively. We used the PK-VFQ, a modified version of the Visual Function Index-14, combined with clinical examinations before and at 6 and 12 months after PK. We used multivariate linear regression models to examine predictors of change in PK-VFQ scores. RESULTS We studied 74 grafts in 71 eyes of 67 patients aged 23 to 91 (mean, 61) years who were followed up for at least 6 months. Indications for surgery included bullous keratopathy (27%), scarring (16%), keratoconus (16%), dystrophies (16%), and regrafts (15%). Median preoperative visual acuity was 20/200 in the graft candidate and 20/30 in the best eye. Median best-corrected postoperative visual acuity in the operated eyes was 20/60 at 6 months. PK-VFQ scores improved at 6 months in 79% by an average of 13.0 points (range, -16.7 to 67.5). Improvement in PK-VFQ scores was associated with younger age (P =.04), poorer preoperative visual acuity in the best eye (P =.001), and postoperative contact lens use (P =.04) but not with postoperative acuity in the grafted eye (P =.49). Postoperatively, 80% of patients were moderately to very satisfied with their vision, and 97% of patients stated they would have the surgery again. CONCLUSIONS Improvement in visual function is inversely associated with visual acuity in the better-seeing eye but does not correlate with the postoperative acuity in the grafted eye. Although most keratoplasties are done unilaterally in the setting of good visual acuity in the contralateral eye, for the majority of patients visual function improves after PK.

Conjunctival Myxoma: A Clinicopathologic Study

A 54-year-old white man had a slowly growing painless epibulbar mass that clinically mimicked a lymphangioma. Morphologically, the paucicellular tumor contained stellate and spindly cells, mast cells, and dilated lymphatic channels embedded in a loose collagenous matrix. The clinical differential diagnosis included lymphangioma, amelanotic nevus, lymphoma, reactive lymphoid hyperplasia, dermoid, lipoma, and botryoid rhabdomyosarcoma. Pathologically, lymphangioma, myxoid neurofibroma, and spindle cell lipoma were all considered. The authors discuss the clinical and histopathologic features of the various tumors, and confirmation of the diagnosis of conjunctival myxoma by differential alcian blue staining properties dependent on critical electrolyte concentration.

RNA metabolism in cultures of corneal stromal cells from patients with keratoconus.

Abstract Total cellular RNA was extracted from cultured keratoconus and normal human corneal stromal cells. The translational activity of these RNAs was examined in a cell-free translation system derived from reticulocyte lysate. Results indicated that keratoconus cells can be separated into two groups, as has been shown previously. Group I keratoconus cells contained the same amount of total RNA as normal cells. RNA activity and the rate of mRNA synthesis in this group of keratoconus cells were also normal. By these criteria it seems that the protein synthesizing system is functioning properly, and group I keratoconus cells should have a normal rate of protein synthesis. These results correlate well with previous findings. Group II keratoconus cells, in contrast, contained more RNA than normal cells. The translational efficiency of RNA was so markedly reduced that the elevation in RNA content did not compensate for the decrease in translational efficiency. It is likely that the reduced protein and collagen synthesis in this group of cells is related to the reduction in the RNA activity. An inhibitory component was present in the keratoconus RNA which affected synthesis of all proteins and suppressed translation of normal RNA.

Lysis of herpes simplex virus-infected targets: II. Nature of the effector cells

Peripheral blood lymphocytes (PBL) from patients with herpes simplex virus (HSV)-1 recurrences in the cornea only (Group I) exhibited reduced lysis of HSV-1-infected targets compared to PBL from patients with oral-facial and corneal HSV recurrences (Group II). The cytotoxic lymphocytes appeared to belong to a subpopulation of natural killer (NK-HSV) cells. Monoclonal antibodies to human lymphocyte differentiation antigens were used to define the surface phenotype of the NK-HSV cells. Most of the NK-HSV activity was mediated by lymphocytes expressing the surface markers Leu-7+ (HNK-1), OKT3+ (pan T), OKM1+ (myeloid and NK), Leu-2- (cytotoxic/suppressor T cell), and Leu-8- (regulatory T cell). In contrast, lysis of K562 cells (NK-K562) was mediated by lymphocytes bearing the surface phenotype Leu-7+, OKT3-, OKM1+, Leu-2+/-, and Leu-8-. The low level of NK-HSV activity in PBL from Group I donors appeared to be due to active suppression by suppressor T lymphocytes. Depletion of Leu-2+ cells from PBL of Group I donors resulted in significant augmentation of NK-HSV activity. Similar treatment of PBL from Group II donors either had no effect or slightly diminished the NK-HSV activity.

Automated Vitrectomy in Eyes with Vitreocorneal Touch Associated with Corneal Dysfunction

Of the results evaluated in 17 patients who had vitrectomy for aphakic vitreocorneal touch associated with corneal edema, nine patients had satisfactory results. Factors associated with a favorable outcome were as follows: (1) early vitrectomy; (2) previtrectomy visual acuity better than 6/120 (20/400); (3) uncomplicated cataract operation and postoperative course, and (4) broken rather than intact hyaloid face. Postoperative cystoid macular edema contributed to decreased visual acuity in eight of 12 patients.

Lysis of herpes simplex virus (HSV) infected targets. I. A comparison of the activity of lymphocytes from patients with HSV recurrences at different anatomical sites

The lysis of herpes simplex virus type I (HSV-1) infected allogeneic targets by peripheral blood lymphocytes (PBL) from patients with recurrent HSV lesions at different anatomical sites was compared. Eighteen patients with recurrent HSV lesions of the cornea, but with no history of HSV recurrences at other anatomical sites (Group I donors); 13 patients with corneal HSV and oral-facial HSV recurrences (Group II donors); and 24 donors with no history of HSV recurrences (control donors) were included in the study. PBL from Group I donors demonstrated low levels of cytotoxicity for HSV-1 infected allogeneic targets relative to controls (p less than 0.001) and Group II donors (p less than 0.001). This low level of lytic activity against HSV infected allogeneic targets was associated with depressed natural killer lysis of K562 cells (NK-K562). PBL from Group II donors did not demonstrate depressed NK-K562 activity. Furthermore, after incubation for 48 hours with HSV-1, PBL from Group II donors showed increased lytic activity against allogeneic HSV infected targets, autologous blast cell targets, and HSV-1 infected autologous blast cell targets, relative to PBL incubated without HSV-1. Similar incubation with HSV-1 of PBL from Group I donors did not result in increased lytic activity.