Steven E. Wilson

Corneal topography of keratoconus

&NA; Sixty‐three eyes of 49 patients with keratoconus were studied by means of computer‐assisted corneal topographic analysis. Two patients with keratoconus in one eye had no topographic evidence of keratoconus in the opposite eye. Keratoconic topographic alterations were classified into two groups. The majority of the patients (72%) had peripheral cones, with steepening extending to the limbus. In this group, the steepening was commonly restricted to one or two quadrants. In some cases, however, the changes involved nearly the entire corneal surface. The remaining group (about one quarter of the keratoconus patients) had steepening that was restricted to the central cornea. In either group, the topographic alterations in the two eyes of any single patient were characterized by a high degree of nonsuperimposable mirrorimage symmetry (enantiomorphism). In the majority of patients, however, there was a large and statistically significant disparity between the two eyes in the power at the apex of the cone and the total cylinder [mean differences 8.2 ± 6.0 D (p < 0.0001) and 4.3 ± 2.7 D (p < 0.0001), respectively].

Screening for Corneal Topographic Abnormalities before Refractive Surgery

PURPOSE The purpose of this prospective study is to evaluate the corneal topography of patients who sought an opinion regarding refractive surgery for the correction of myopia. METHODS Both eyes of 53 patients were evaluated with a topographic modeling system. Forty-two patients wore contact lenses (84 eyes: 36 rigid contact lenses and 48 soft contact lenses). Ten patients (20 eyes) wore glasses alone and one patient (2 eyes) wore neither glasses nor contact lenses for correction of myopia. RESULTS Thirty-five (33%) of 106 eyes were found to have abnormal corneal topography. Of the 42 patients (84 eyes) who wore contact lenses, 32 eyes (38%) had irregular astigmatism, loss of radial symmetry, or absence of the normal progressive flattening from the center to the periphery of the cornea, consistent with contact lens-induced corneal warpage. Alterations were more frequent and severe in rigid contact lens wearers. Three patients (5.7%) received a diagnosis of definite keratoconus, a higher incidence than has been reported in the general population. Topographic abnormalities in most, if not all, of the eyes would not have been detected by visual inspection of the photokeratoscopic images alone. CONCLUSIONS Appropriate preoperative detection and management of corneal topographic abnormalities are essential steps in every refractive surgical procedure. The overall efficacy and safety of procedures such as radial keratotomy and photorefractive keratectomy likely will be improved once the unpredictable variables of contact lens-induced warpage and occult ectatic disease are eliminated by topographic screening before surgery. Patients with keratoconus may be over-represented in the refractive surgery population due to self-selection.

Advances in the analysis of corneal topography

Recent advances in topographic analysis have provided powerful tools for detecting subtle, but clinically significant, alterations of corneal contour. This article compares keratometry, keratoscopy, and computer-assisted topographic analysis and provides specific examples of the sensitivity of computer-assisted systems in revealing topographic alterations that were not previously discernable. Quantitative descriptors of corneal topography such as the surface asymmetry index, the surface regularity index, and simulated keratometry value augment the information provided by color-coded topographic maps.

Prostaglandin F2α-1-Isopropylester Lowers Intraocular Pressure Without Decreasing Aqueous Humor Flow

Using fluorophotometry, we performed a randomized, dose-response study of the effects of a prostaglandin derivative on aqueous humor flow. Prostaglandin F2 alpha 1-isopropylester, 0.224 micrograms, 0.448 micrograms, and 1.120 micrograms, in saline with polysorbate 80 was instilled into one eye of 20 subjects in three separate dose studies. Polysorbate 80 in saline was instilled in the fellow eye as a control. The drug had no measurable effect on aqueous humor flow or corneal endothelial permeability. Intraocular pressure measured eight hours after administration of the highest dose, 1.120 micrograms, was 20% lower in the treated eye as compared to the fellow eye (P less than .001).

Quantitative Descriptors of Corneal Shape Derived from Computer-assisted Analysis of Photokeratographs

The goal of this retrospective study was to derive clinically useful quantitative measures of corneal shape from computer-assisted analyses of photokeratoscope photographs. Algorithms were developed to determine a new index of corneal symmetry, the Surface Asymmetry Index (SAI). The SAI correlated well with best spectacle-corrected visual acuity and may be useful clinically for predicting the level of spectacle-corrected visual acuity that could be expected based on the corneal surface topography in the otherwise normal eye of an individual patient. Algorithms were also developed to determine the centrally-weighted average corneal power and the power and location of the steepest and flattest corneal meridians. The average surface power and the power of the steepest meridian determined from the photokeratographs correlated well with values obtained using the keratometer in the retrospective series (correlation coefficient = 0.98 for the average surface power and 0.97 for the power of the steepest meridian).

Accuracy and precision of the corneal analysis system and the topographic modeling system

Two computer-assisted topographic analysis systems were evaluated with calibrated spherical surfaces and normal human corneas. The Topographic Modeling System-1 (TMS-1) was found to be statistically more accurate in determing the power of calibrated spheres near the apex and at 1 mm from the apex than the Corneal Analysis System(CAS).The CAS, however, was statistically more accurate at 3 mm from the apex with each calibrated sphere. The small differences in accuracy between the two instruments, however, are unlikely to be of clinical significance. The topographic patterns on color-coded maps from 22 normal corneas of 11 subjects were similar with the two instruments. Simulated keratometry values with the CAS more accurately identified the keratometerdetermined major cylinder axis compared with the TMS- 1. Conversely, the TMS-1 was more accurate than the CAS at determining the level of corneal astigmatism.

Mooren-type hepatitis C virus-associated corneal ulceration

BACKGROUND Two patients with bilateral Mooren-type ulcers had underlying chronic hepatitis C virus (HCV) infection. Both patients also had chronic, pruritic dermatitis, which in one patient was diagnosed as hidradenitis suppurativa. METHODS Serum from the first patient and serum, conjunctiva, and liver from the second patient were analyzed for HCV genomic RNA using the reverse transcriptase-polymerase chain reaction. Serum anti-HCV antibodies were monitored with a commercially available second-generation test. Liver and conjunctival biopsies were evaluated histopathologically. RESULTS Liver biopsy showed severe hepatitis in the first patient, but normal liver tissue in the second. Hepatitis C virus genomic RNA was detected in the serum of both patients. In the first patient, the virus was detected 4 months after completion of interferon alfa-2b treatment for chronic active hepatitis. In the second patient, HCV genomic RNA was detected in serum, but not in conjunctiva or liver tissue. Hepatitis C virus could not be detected in the serum of the second patient after 2 weeks of interferon alfa-2b treatment. Both patients had serum anti-HCV antibodies. In case 1, there was a marked improvement in the corneal disease during and after 6 months of interferon alfa-2b treatment for chronic active hepatitis that paralleled a return of serum liver enzyme levels to the normal range. In the second patient, the corneal disease improved after 6 weeks of interferon alfa-2b treatment, but abruptly worsened when the patient discontinued therapy. The corneal disease improved again after interferon alfa-2b was reinstituted. CONCLUSIONS Chronic HCV virus infection is associated with Mooren-type peripheral ulcerative keratitis. All patients with Mooren-type ulcers should be tested for evidence of HCV infection in consultation with a liver specialist. Even when improvement is obtained with interferon alfa-2b treatment, however, continued follow-up is important because relapse is common and repeat treatment may be effective.

Corneal topographic alterations in normal contact lens wearers

PURPOSE The purpose of this study is to investigate the corneal topography of visually normal asymptomatic eyes that wore rigid and soft contact lenses compared with visually normal eyes that had never worn contact lenses. METHODS Thirty-seven normal corneas and 74 corneas in asymptomatic eyes that wore rigid (12 polymethylmethacrylate and 23 gas-permeable) and soft (26 daily-wear and 13 extended-wear) contact lenses for refractive correction underwent slit-lamp examination, keratometry, computer-assisted topographic analysis, refraction, and rigid contact lens over-refraction. RESULTS Topographic abnormalities tended to be more common and more severe in corneas that wore rigid contact lenses, but significant changes were noted in some eyes that wore daily-wear or extended-wear soft contact lenses. A number of eyes in the rigid polymethylmethacrylate (9 of 12) and rigid gas-permeable (6 of 23) contact lens groups had a correlation between the most frequent resting position of the contact lens and the corneal topography, with relative flattening of the corneal contour beneath a decentered lens. A total of 10 eyes in the rigid contact lens groups had a 1-line decrease in best spectacle-corrected visual acuity attributable to contact lens-induced topographic abnormalities. CONCLUSIONS Corneal topographic alterations are common in asymptomatic contact lens wearers and are frequently detectable only with computer-assisted topographic analysis. It is important that topographic abnormalities be excluded in contact lens wearing eyes before refractive surgical procedures.

Epidermal growth factor messenger RNA production in human lacrimal gland.

Experimental models and clinical investigations have suggested that epidermal growth factor (EGF) may have a role in corneal wound healing. It has been identified as a normal component of human tears. Rabbit and mouse lacrimal glands have recently been shown to synthesize EGF messenger RNA (mRNA). The purpose of the present study was to determine whether the human lacrimal gland synthesizes EGF mRNA. Total cellular RNA was isolated from pathologic specimens of normal human lacrimal glands from two individuals. Reverse transcriptase was used to generate complementary DNA (cDNA) using a human EGF-specific mRNA primer. Amplification of EGF-related cDNA sequences was performed with the polymerase chain reaction (PCR) and human EGF-derived up- and downstream primers. The PCR products from both lacrimal glands contained an amplified product of the expected length of approximately 410 base pairs. The PCR-generated fragment was verified as an EGF-related amplification product with Southern blotting using a synthetic oligonucleotide probe derived from the mature coding sequence of EGF. These results conclusively demonstrate that the human lacrimal gland synthesizes EGF and suggest that the lacrimal gland could have a regulatory role in maintaining the ocular surface and possibly regulating corneal wound healing through the secretion of EGF.

Interferon Treatment of Mooren's Ulcers Associated With Hepatitis C

PURPOSE/METHODS The cause of Moorens ulcer is unknown. We examined a patient with chronic hepatitis C who had a corneal ulceration that resembled Moorens corneal ulcer. RESULTS/CONCLUSION The corneal ulceration progressed despite appropriate medical and surgical interventions. Recombinant interferon alpha 2b finally led to resolution of the process. The resolution correlated with normalization of the patients liver function tests. Corneal ulcerations that resemble Moorens ulcer may be associated with hepatitis C. Recombinant interferon alpha 2b seems to induce remission in the corneal as well as the systemic condition.