Yves Pouliquen

Nineteen years of penetrating keratoplasty in the Hotel-Dieu Hospital in Paris.

Purpose. To identify changing trends in penetrating keratoplasties (PKs) performed at the Hotel-Dieu Hospital in Paris between January 1980 and December 1999 and to explain the reasons for the changes. Methods. We retrospectively reviewed 3,736 of the 3,836 PKs performed between January 1, 1980, and December 31, 1999, and classified them into diagnostic categories. Results. The most common indications for PK were keratoconus (28.8%), herpetic infections (10.9%), graft failures (9.9%), aphakic and pseudophakic corneal edema (9.9%), Fuchs endothelial dystrophy (9.4%), and nonherpetic leucoma (7.7%). Other indications represented 23.4% of the cases. The incidence of aphakic and pseudophakic corneal edema progressively increased between 1980 and 1991, became the most frequent indication in 1991 (21.4%), and then progressively decreased. The annual number of PKs increased between 1980 and 1986, decreased between 1987 and 1997, and increased again after September 1997. The decrease was caused by both a shortage of corneal buttons, and, in 1987, the fear of transmitting diseases through corneal transplantation, particularly human immunodeficiency virus. Beginning in 1992, decreases were also associated with stringent governmental regulations of eye bank tissue. Conclusion. Changes in the incidence and management of corneal disorders were the primary factors leading to modifications of grafting until 1987. After 1987, corneal button shortage probably corresponded to the acquired immune deficiency syndrome epidemic. Governmental regulations of eye banking led to a severe corneal button shortage between 1992 and 1997. Despite an increase in the number of PKs performed after 1997, corneal buttons are still preferentially allocated to patients in whom there is a high probability of graft success.

Recurrence of keratoconus characteristics: A clinical and histologic follow-up analysis of donor grafts

PURPOSEnTo report on clinical corneal topography, histopathologic analysis, and fine structure findings in failed grafts after penetrating keratoplasty (PK) for keratoconus (KC).nnnDESIGNnRetrospective, consecutive, interventional case series with histologic and clinical correlation.nnnPARTICIPANTSnTwelve corneal buttons were obtained from consecutive patients undergoing repeated PK 10 to 28 years after the initial PK for KC. The indication for regrafting was endothelial deficiency in seven cases, irreversible immune graft rejection in two cases, and corneal ectasia in three cases.nnnMETHODSnRemoved corneal buttons were examined by light and transmission electron microscopy. A potential correlation between the clinical and videokeratoscopic findings and the microscopic structural observations was analyzed.nnnRESULTSnPreoperative simulated keratometry measured by TMS-1 (Tomey, New York, NY) or EyeSys CAS (EyeSys Technology, Houston, TX) ranged from 49.8 to 66.1 diopters. A pattern compatible with KC characteristics was observed in all cases. Fine structure analysis revealed Bowmans layer disruption or folds and stromal deposits in all corneal buttons. However, central corneal thinning was not present in any of the removed buttons.nnnCONCLUSIONSnStructure changes compatible with the diagnosis of KC were observed in all donor buttons many years after PK on KC recipients. Recurrence of the KC characteristics may result from graft repopulation by recipients keratocytes, aging of the grafted tissue, or both.

A Prospective Randomized Trial of Topical Soluble 0.1% Indomethacin Versus 0.1% Diclofenac Versus Placebo for the Control of Pain Following Excimer Laser Photorefractive Keratectomy

BACKGROUND AND OBJECTIVEnTo compare the safety and efficacy of topical nonsteroidal antiinflammatory drugs (NSAIDs) for the control of pain after excimer laser photorefractive keratectomy (PRK).nnnPATIENTS AND METHODSnOne hundred twenty informed patients were enrolled in a double-masked, randomized, comparative study and assigned to either 0.1% indomethacin, 0.1% diclofenac, or placebo treatment. Subjective postoperative pain, symptoms, re-epithelialization rate, and systemic medications were monitored for 2 days following photoablation.nnnRESULTSnCompared with the placebo, 0.1% indomethacin solution significantly reduced pain on the day of surgery (D0) (P < .05), whereas 0.1% diclofenac did not reach a significant level (P = .46). At D0, analgesic intake by the oral route was significantly greater in the placebo group (P < .05). Severe photophobia was significantly less frequent in the group treated with 0.1% indomethacin (P < .05). Corneal wound healing was significantly delayed in the patients treated with 0.1% diclofenac at D2 as compared with other groups (P = .04).nnnCONCLUSIONnTopical 0.1% indomethacin solution helps control the pain induced by excimer laser photoablation of the cornea without any detrimental effect to the corneal epithelial wound healing.

Clinical, histologic, and ultrastructural features of the corneal dystrophy caused by the R124L mutation of the BIGH3 gene

OBJECTIVEnThis study was designed to describe the clinical, histologic, and ultrastructural features of the corneal dystrophy associated with the R124L mutation of the BIGH3 gene.nnnDESIGNnRetrospective clinical and histologic review of a new genetic mutation.nnnPARTICIPANTSnThirty-four patients from five unrelated French families with corneal dystrophy caused by the R124L mutation of the BIGH3 gene were studied at the clinical, histologic, and ultrastructural levels. Records of patients carrying this mutation were compared with those from three unrelated patients with corneal dystrophy of Bowmans layer (CDB) type 2 (R555Q mutation) and from three unrelated patients with classic corneal granular dystrophy (R555W mutation).nnnINTERVENTIONnThe mutational genetic status of the BIGH3 gene was determined for each patient, and the histologic and ultrastructural data available after corneal graft were analyzed.nnnMAIN OUTCOMES MEASURESnGenomic DNA was extracted from peripheral blood leukocytes. Exons 4 and 12 of the BIGH3 gene were amplified by the polymerase chain reaction (PCR), and the PCR products were directly sequenced.nnnRESULTSnAll 34 patients with the R124L mutation displayed the clinical, histologic, and electron microscopic features of the dystrophy previously described as a superficial variant of corneal granular dystrophy. Combining molecular genetics with clinical and histologic findings established a clear distinction between the R555Q and R555W dystrophies.nnnCONCLUSIONSnThe R124L mutation of the BIGH3 gene is associated with specific clinical and morphologic criteria. This indicates that molecular studies are needed for an adequate classification of corneal dystrophies. All criteria are presently available to segregate the dystrophy caused by the R124L mutation (known as CDB1) from the dystrophy caused by the R555Q mutation (known as CDB2).

Encapsulation of scleral buckling materials: A study of sixty specimens

OBJECTIVEnThe purpose of the study was to obtain information on the encapsulation of two nonabsorbable biomaterials (silicone and hydrogel) used as explants in scleral buckling in retinal detachment surgery.nnnDESIGNnThe study design was a histopathologic study on a cohort of capsule fractions and complete eyes.nnnPARTICIPANTSnFifty-nine patients participated in this study, in which 60 specimens, including 37 hydrogel and 21 silicone capsule specimens as well as 2 whole eyes, were gathered. There were no control subjects.nnnINTERVENTIONnThe capsule specimens were obtained from eyes operated on previously for scleral buckling for retinal detachment. The two whole eyes were enucleated. All specimens were studied with routine optic microscopy.nnnMAIN OUTCOME MEASURESnPatient characteristics, type of scleral buckling, and number of operations performed were analyzed. Histologically, the capsular structure, its interface with the explant, and its different components also were studied. Remnants of the buckling material also were investigated.nnnRESULTSnThere were 45 male and 14 female patients, with a mean age of 49 years. Histologically, capsule specimens had a fibrous matrix with fibroblasts and few inflammatory cells. Eighteen (48.6%) of 37 hydrogel capsule specimens displayed hydrogel fragments surrounded by a foreign body giant cell granuloma in 16 cases.nnnCONCLUSIONnNonabsorbable materials undergo encapsulation after implantation on the eye surface. Giant cell granuloma was observed in some hydrogel capsule specimens in relation to hydrogel fragmentation. The exact origin of this fragmentation remains unknown.

Statistical morphometric studies in normal human and rabbit corneal stroma

Abstract Techniques and methods are described at the useful mathematical level in quantitative morphometric studies on electron-microscope photographs of normal human and rabbit corneal stroma. The results obtained are discussed.

Persistent corneal opacity after oral isotretinoin therapy for acne.

This case report describes a case of persistent corneal opacity after oral absorption of isotretinoin. Isotretinoin has ocular side effect. These effects generally have no influence on visual acuity, although serious ocular adverse reactions have been reported. Isotretinoin should be discontinued if these symptoms occur. Appearance of hundreds or thousands of fine, rounded, white to gray lesions of various sizes was previously related to the use of isotretinoin therapy. Lesions were localized in the superficial stroma of the cornea (1). These side effects disappeared once the drug was discontinued in all previously reported cases (1). This patient developed these typical corneal lesions, but they have persisted for 6 years after the isotretinoin was discontinued.

Interfibrillar structures in fast-frozen, deep-etched and rotary-shadowed extracellular matrix of the rabbit corneal stroma

Cette methode a permis de mettre en evidence de nouvelles caracteristiques structurales tridimensionnelles in situ des constituants interfibrillaire du stroma de la cornee du lapin. On ignore si les differentes structures correspondent a des constituants moleculaires ou macromoleculaires differents. Les structures du type pilier qui sont frequemment orthogonalement liees aux principales fibrilles de collagene a bandes transversales representent des proteoglycanes. Celles-ci sont indispensables pour lorganisation spatiale precise des fibrilles de collagene et de ce fait pour la qualite optique de la cornee

Cytochemical study of macular dystrophy of the cornea (Groenouw II): an ultrastructural study

Abstract A cytochemical study of a case of macular dystrophy (Groenouw II) by means of optical and electron microscopy is reported. The epithelial lesions are slighter than the stromal lesions. The keratocytes are the site of important degeneration. The substance secreted by these cells is PAS-positive under both the optical and electron microscope. It is also alcianophil. This substance may be a glycoprotein rather than an acid mucopolysaccharide. The simultaneous positivity of the PAS reaction and the Alcian blue stain argues in favour of the hypothesis, which should be confirmed by a biochemical study.

The phenomena of reabsorption in the course of cicatrization of experimental wounds of the cornea (ultrastructural study)

Abstract The authors present a study by electron microscopy of avascular inflammation of the cornea resulting from a linear, central, transfixed wound of the cornea in rat. The animals were sacrificed at different times after the trauma: 4, 24, 48 hr, 7 and 15 days. Around the wound is produced a “necrosis” of connective tissue. During the initial stages of inflammatory reaction, the phenomena of reabsorption are assured by different cells. The phagocytic activity of polynuclear neutrophils coming from the pre-corneal action film and the limbus is early and important. It depends upon epithelial factors. The action of the polynuclear cells is not limited to phagocytosis. By liberating in their surroundings the proteolytic enzymes contained in the lysosomes, these cells participate in the alteration of extracellular material. The action of the granulocytes is completed by the 48th hr by that of the macrophages. These result from the transformation of histiomonocytic cells located in the vessels of the limbus. The fibroblasts do not seem to become macrophages. At best, they possess certain histiocytic properties. The cells called “polygonal”, located in the epithelium, corresponding to the “branched cells” of the Japanese authors manifest a phagocytic activity with regard to fibrin.