Liv Drolsum

Phacoemulsification in eyes with pseudoexfoliation.

Purpose: To compare intraoperative and postoperative complications in eyes with and without pseudoexfoliation having cataract surgery by phacoemulsification. Setting: Department of Ophthalmology, National Hospital, Oslo, Norway. Methods: Of 1152 consecutive phacoemulsification procedures, 164 cases with pseudoexfoliation (Group 1) and 916 cases without (Group 2) were followed for 4 months after cataract surgery in a prospective study. Of all cataract operations performed during that time, 96.2% were phacoemulsification procedures: 90.4 and 97.4% in eyes with and without pseudoexfoliation, respectively (P < .0005). Results: The frequency of capsular/zonular tear or vitreous loss was 9.6 and 3.7% in Groups 1 and 2, respectively (P = .0002). A visual acuity of 0.5 or better was achieved in 86.5% of eyes in Group 1 and 92.4% in Group 2 (P = .02). There were no statistically significant between‐group differences in the frequency of a postoperative inflammatory response 1 day (6.7 versus 4.4%), 1 week (2.4 versus 1.6%), or 4 months (1.8 versus 0.9%) postoperatively. Conclusion: Phacoemulsification was safe in most eyes with pseudoexfoliation even though significantly more complications occurred intraoperatively in these eyes. The low frequency of an inflammatory response indicates that the presence of pseudoexfoliation does not significantly increase the risk of inflammation.

Trabeculectomies. A long-term study.

Abstract This study comprises 277 primary open‐angle glaucomas in 239 patients followed up to 10 years after trabeculectomy. Sixty‐four per cent had capsular glaucoma and 36% simple glaucoma. The number of cases showing no progression of glaucoma damage and not needing additional medical therapy decreased slowly with time. Seventy‐five per cent showed no progress after one year, 70% after 2 years, 57% after 5 years and 42% after 10 years. There was a significant trend that fewer capsular glaucomas progressed than simple glaucomas. High pressure levels before trabeculectomy did not indicate a bad prognosis. Cases with advanced or moderate glaucomatous damage seemed to have the same prognosis. Cataract was a common complication; a 50% reduction of preoperative visual acuity was found in 37% of eyes after 5 years of follow‐up.

Ex vivo expanded autologous limbal epithelial cells on amniotic membrane using a culture medium with human serum as single supplement.

In patients with limbal stem cell deficiency (LSCD), transplantation of ex vivo expanded human limbal epithelial cells (HLECs) can restore the structural and functional integrity of the corneal surface. However, the protocol for cultivation and transplantation of HLECs differ significantly, and in most protocols growth additives such as cholera toxins, exogenous growth factors, hormones and fetal calf serum are used. In the present article, we compare for the first time human limbal epithelial cells (HLECs) cultivated on human amniotic membrane (HAM) in a complex medium (COM) including fetal bovine serum to a medium with human serum as single growth supplement (HSM), and report on our first examinations of HLECs expanded in autologous HSM and used for transplant procedures in patients with LSCD. Expanded HLECs were examined by genome-wide microarray, RT-PCR, Western blotting, and for cell viability, morphology, expression of immunohistochemical markers and colony forming efficiency. Cultivation of HLECs in HSM produced a multilayered epithelium where cells with markers associated with LESCs were detected in the basal layers. There were few transcriptional differences and comparable cell viability between cells cultivated in HSM and COM. The p63 gene associated with LESCs were expressed 3.5 fold more in HSM compared to COM, and Western blotting confirmed a stronger p63α band in HSM cultures. The cornea-specific keratin CK12 was equally found in both culture conditions, while there were significantly more CK3 positive cells in HSM. Cells in epithelial sheets on HAM remaining after transplant surgery of patients with LSCD expressed central epithelial characteristics, and dissociated cells cultured at low density on growth-arrested fibroblasts produced clones containing 21 ± 12% cells positive for p63α (n = 3). In conclusion, a culture medium without growth additives derived from animals or from animal cell cultures and with human serum as single growth supplement may serve as an equivalent replacement for the commonly used complex medium for ex vivo expansion of HLECs on HAM.

Risk factors for an inflammatory response after extracapsular cataract extraction and posterior chamber IOL

Abstract. Risk factors for developing an inflammatory response after extracapsular cataract extraction with implantation of posterior chamber IOL have been studied. Out of 1154 cases included in the study, an inflammatory response was encountered in 63 eyes (5.5%). The inflammatory response was defined as increased cellular flare and/or as a fibrinous reaction during a follow‐up of 4 months. Thirteen of the 63 eyes (20.6%) developed cellular precipitates, and posterior synechias were seen in 34 of these eyes (54.0%). Among 10 pre‐ and 10 peroperative putative risk factors analyzed in a logistic regression model, 5 variables had a statistically significant influence on the probability of developing postoperative inflammation; 1) Uveitis in history (p = 0.0001), 2) Pseudo‐exfoliation syndrome (p = 0.0224), 3) Inability to obtain adequate mydriasis at the start of surgery (p < 0.0001), 4) Problems with IOL implantation (p = 0.0111) and 5) Pigment effusion during surgery (p = 0.0258).

Pseudoexfoliation syndrome and extracapsular cataract extraction.

Abstract. Extracapsular cataract extraction (ECCE) in 139 eyes with pseudoexfoliation syndrome was compared to 762 eyes without pseudoexfoliation syndrome in a consecutive study. Preoperative findings, operative procedure and problems were registered, stored and analyzed in a computer program package. Of the patients with pseudoexfoliation syndrome 88.5% were 70 years or older, compared to 67.2% of the patients without pseudoexfoliation syndrome (p < 0.001). Glaucoma occurred in 48.9% of eyes with pseudoexfoliation syndrome and in 6.8% of eyes without pseudoexfoliation syndrome, respectively. Poorly dilated pupil was demonstrated in 46.8% and in 5.8% of eyes with and without pseudoexfoliation syndrome, respectively. Capsule/zonulae tears (without vitreous loss) occurred in 4.3% of the pseudoexfoliation syndrome eyes, compared to 1.3% in eyes without pseudoexfoliation syndrome (p < 0.05). The incidence of vitreous loss was similar in both groups. We found no correlation between the pupil size and capsule/zonulae tears or vitreous loss in either group. In conclusion, when appropriate care is undertaken, ECCE with posterior chamber IOL implantation is a safe procedure in pseudoexfoliation syndrome eyes.

Causes of decreased visual acuity after cataract extraction

Abstract We analyzed a consecutive series of cataract extractions to determine the causes of unsuccessful results. Our criterion was a decrease in visual acuity from the preoperative measurement. Fourteen of 1237 eyes met this criterion. In three of the 14, visual acuity was decreased by more than two Snellen lines. Vitreous loss occurred in seven of the eyes. In six of these, cystoid macular edema developed. The reasons for reduced visual acuity were cystoid macular edema (eight eyes), an aggravation of age‐related maculopathy (three eyes), and vitreous hemorrhage and herpetic keratitis (one eye each). A branch vein occlusion caused macular edema and vitreous hemorrhage in one eye. From this data, we recognize the importance of avoiding vitreous loss. If it does occur, we recommend that meticulous anterior vitrectomy be performed, with as little manipulation as possible.

A novel method for preserving cultured limbal epithelial cells

Aim: To investigate organ culture preservation of cultured limbal epithelial cells in order to enhance the availability of tissue-engineered epithelia that are used to treat patients with limbal stem cell deficiency. Methods: Limbal epithelial cells were cultured for 3 weeks on intact amniotic membrane fastened to a polyester membrane carrier. The cultured epithelia were stored for 1 week at 23°C in organ culture medium. The preserved epithelia were then examined using a colorimetric cell viability assay, light microscopy and immunohistochemistry. Results: The viability of the preserved epithelia was 84% (20%), and no statistically significant difference was found compared with non-preserved epithelia. In general, the cell borders were maintained, the nuclei showed no sign of degeneration, and the original layered structure was preserved. Mild intercellular oedema was occasionally observed. Expression of p63, K19 and vimentin was maintained. Conclusions: Cultured limbal epithelial cells can be preserved in organ culture medium for 1 week at room temperature, while maintaining the original layered structure and undifferentiated phenotype.

Long-term follow-up of secondary flexible, open-loop, anterior chamber intraocular lenses

Purpose: To evaluate the long‐term results of secondary implantation of modern flexible, open‐loop, anterior chamber intraocular lenses (IOLs). Setting: Department of Ophthalmology, National University Hospital, Oslo, Norway. Methods: This prospective study comprised 18 patients (20 aphakic eyes) who had secondary IOL implantation from January 1990 to May 1992. In an earlier report, these patients were followed for 4 months. The patients were reexamined in October 1998. The mean follow‐up was 93.8 months ± 6.0 (SD). Two patients had died. No others were lost to follow‐up. The intraocular pressure (IOP) in the remaining 16 patients (18 eyes) was compared to that 4 months postoperatively. Visual acuity was compared to the preoperative measurements. A complete slitlamp examination was performed, and complications were noted. Results: There was no statistical decrease in visual acuity during the follow‐up. The mean IOP was 16.6 ± 5.7 mm Hg (range 8 to 27 mm Hg) in 1998 and 13.4 ± 3.4 mm Hg (range 7 to 19 mm Hg) 4 months postoperatively. The difference was statistically significant (P = .037). Corneal pathology was seen in 3 eyes, 1 of which had developed corneal decompensation. One patient had surgery for retinal detachment 4 years postoperatively. The pupil was deformed in 5 eyes. Conclusions: This long‐term study demonstrates that secondary implantation of flexible, open‐loop, anterior chamber IOLs is safe in selected eyes. Anterior chamber IOLs should not be used in eyes with corneal problems and should be used with caution in eyes with glaucoma. These patients require close, continued observation to look for late complications such as IOP elevation.

Results and complications after extracapsular cataract extraction in eyes with pseudoexfoliation syndrome

Abstract. Postoperative results and complications in 136 eyes with pseudoexfoliation syndrome were compared to 744 eyes without pseudoexfoliation syndrome in a consecutive study. The patients were followed for 4 months postoperatively. Excluding cases with glaucoma, 81.4% of the pseudoexfoliation eyes and 83.0% of the eyes without pseudoexfoliation achieved a corrected visual acuity of 5/8.5 or better. IOL malposition was rare in both groups (1.5% in the pseudoexfoliation group and 1.6% in the group without pseudoexfoliation). IOP elevation the first day postoperatively occurred most often in the pseudoexfoliation eyes. In the pseudoexfoliation eyes, postoperative iritis and cellular precipitates were demonstrated in 16.2% and 11.0%, respectively, compared to 3.8% and 3.2% in the eyes without pseudoexfoliation (p < 0.001). The frequency of an inflammatory reaction was highly correlated to small pupil size during operation in both groups.

Does Corneal Collagen Cross-linking Reduce the Need for Keratoplasties in Patients With Keratoconus?

Purpose: To investigate whether the introduction of corneal collagen cross-linking (CXL) influences the frequency of keratoplasties in patients with keratoconus. Methods: Data were obtained from a cohort of patients from our corneal transplant registry. Two different periods were compared, 2005 to 2006 (period 1) and 2013 to 2014 (period 2). Patients during period 1 had surgery before the introduction of CXL treatment, and patients in period 2 had surgery after this treatment was well established in our department. Age and gender were registered, and the Amsler–Krumeich classification system was applied to grade the degree of keratoconus. Results: The total number of keratoplasties performed during period 1 was 137, and keratoconus was the cause of surgery in 55 eyes (55 patients). The corresponding numbers in period 2 were 231 and 26 eyes (26 patients), respectively. The difference in the number of keratoplasties for keratoconus in both periods was statistically significant (P = 0.003). There were no significant differences in the distributions of age and gender between both periods. In period 1, 63.6% of the eyes were graded as stage 4 in the Amsler–Krumeich classification, compared with 96.2% in period 2 (P = 0.001). Conclusions: The frequency of keratoplasty for keratoconus has been more than halved in our department over the last decade. There is reason to believe that this reduction is for a great part caused by the introduction of CXL treatment.