The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical ... more The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical trials evaluating the effectiveness of histocompatibility matching in high risk keratoplasty patients. The antigen matching study (AMS) evaluated HLA matching in patients without circulating lymphocytotoxic antibody to HLA antigens and the cross-match study (CS) evaluated the effect of using cross-match-negative donors in patients with identified circulating lymphocytotoxic antibodies to HLA antigens. Sera from 510 patients considered for enrollment in the studies were screened preoperatively for the presence of anti-class I lymphocytotoxic antibodies (LA). The 42 patients (8%) found to have detectable LA entered the CS. The 468 patients found not to have detectable LA preoperatively entered the AMS. Fifteen of the 37 transplanted CS patients were found to have donor-specific anti-class I antibody (before or after surgery). These patients were also screened for anti-class II LA and 25 had anti-class II panel reactive antibody > or = 5%. Forty-nine of the 419 transplanted AMS patients (12%) were found to have produced anti-class I LA after surgery, and in 19 patients, antibody specificities were those of donor HLA antigens. There was a significant association between the number of mismatched class I antigens and the number of donor-specific LA produced. The production of LA by AMS patients was significantly associated with reaction episodes; eighty-two percent of patients (40 of 49) with LA had reaction, compared with 63% of patients (230 of 365) without LA (P = 0.02). Likewise, production of donor-specific LA was significantly associated with immune-mediated graft failure (P = 0.025). For CS patients, there was no correlation between the production of donor-specific anti-class I or nonspecific anti-class II antibodies and graft outcome. However, the CS patients had poorer graft survival than did AMS patients at 3 years (57% vs. 66%, P = 0.01). These data demonstrate that LA, especially directed against donor class I HLA antigens following corneal transplantation in high risk patients, are associated with immune graft rejection and can be an indicator of allograft rejection.
To evaluate the safety and efficacy of the removal of INTACS. Subgroup analysis from a nonrandomi... more To evaluate the safety and efficacy of the removal of INTACS. Subgroup analysis from a nonrandomized comparative interventional trial. Four hundred fifty-two patients with best spectacle-corrected visual acuity of 20/20 or better and myopia (1.0-3.5 diopters [D]) were enrolled in the U.S. Food and Drug Administration clinical trials of INTACS. Forty-six eyes among a total of 684 underwent INTACS removal. INTACS removal. Safety and efficacy of INTACS removal was assessed by comparison of results from preoperative and 3-month postremoval visits. Safety was assessed by maintenance of preoperative best spectacle-corrected acuity and induction of astigmatism (measured by manifest refraction). Efficacy was assessed by comparison of mean spherical equivalent measured by both manifest and cycloplegic refraction, as well as percentage of eyes within +/- 0.5 D and +/- 1.0 D of baseline values. A subset of 27 patients completed a prospective questionnaire assessing the frequency of six visual symptoms (glare, halos, double vision, photophobia, night vision difficulties, and fluctuating vision). Best spectacle-corrected visual acuity, manifest refraction, and cycloplegic refraction. Forty-one of 46 patients' eyes that had undergone INTACS removal had reached the 3-month postremoval visit. Of these eyes, 73% (30 of 41) had returned to within +/- 0.5 D and 97% (40 of 41) to within +/- 1.0 D of baseline spherical equivalent as measured by manifest refraction. With respect to astigmatism, 88% (36 of 41) had returned to within +/- 0.5 D and 100% (41 of 41) to within +/- 1.0 D of preoperative value. No patient had a loss of best spectacle-corrected acuity of more than 2 lines, with equal numbers of eyes having a loss or gain of 1 line (nine eyes) and 2 lines (one eye). For most eyes, INTACS removal was associated with a substantial reduction in the six types of visual symptoms; however, in some eyes (up to 15%) symptoms that had not been detected preoperatively were noted after INTACS removal. INTACS removal was not associated with a loss (> 2 lines) of best spectacle-corrected visual acuity or induction (> 1 D) of astigmatism or myopia. INTACS removal was associated with a reversal to preoperative values in most cases.
The pathogenesis of posterior polymorphous dystrophy was analyzed by immunohistologic methods. Se... more The pathogenesis of posterior polymorphous dystrophy was analyzed by immunohistologic methods. Sections of corneal buttons from two patients undergoing transplantation owing to posterior polymorphous dystrophy were stained with 2B4.14.1, a monoclonal antibody that reacts with human corneal endothelium, and with a cocktail of antihuman cytokeratin monoclonal antibodies that do not react with normal corneal endothelium. Single-stained sections revealed a variegated, intermittent staining pattern of antibody reactive and nonreactive cells. Double-stained sections revealed some cells that stained with only one of the antibodies and many cells that stained with both antibodies. The presence of cells staining positively for both 2B4.14.1 antigen and cytokeratins supports the hypothesis that the cytokeratin-expressing epithelial-like cells found in corneas with posterior polymorphous dystrophy arise via a metaplastic process in which the phenotype of endothelial cells becomes progressively abnormal.
As a first step to characterize human meibum and tear lipids, infrared spectroscopy was applied t... more As a first step to characterize human meibum and tear lipids, infrared spectroscopy was applied to characterize the molecular structure/conformation and packing of hydrocarbon chains. Temperature-induced phase transitions were fit to a sigmoid equation and were experimentally reproducible and were similar for multiple samples collected from the same person. No hysteresis was observed. Hydration of polar tear lipids increased their phase transition cooperativity, enthalpy and entropy. Hydrophobic interactions in meibum lipid (ML) were stronger than in tear-fluid lipids (TL), as reflected by the higher entropy and enthalpy of the gel to liquid crystalline phase transition of ML. The results of this study provide further evidence of the differences in the composition and structure of ML and TL. The conformational changes observed in the hydrocarbon chains of ML with temperature suggest that the observed therapeutic increased delivery of ML with eye lid heating could be related to the i...
A 33-year-old man had a unique lens capsular cyst that became clinically evident eight years afte... more A 33-year-old man had a unique lens capsular cyst that became clinically evident eight years after a penetrating ocular injury in which the lens capsule was disrupted. Microscopic examination indicated that the cyst may have arisen from displaced lens capsule and epithelial cells that became separated from the lens.
We have developed a series of temporary keratoprostheses that permit closed pars plana vitrectomy... more We have developed a series of temporary keratoprostheses that permit closed pars plana vitrectomy in eyes with abnormal corneas. These devices are placed into a trephined opening in the cornea, and provide a clear, stable view of the intraocular contents. Immediately after vitrectomy, the keratoprosthesis is replaced with a corneal graft. We have used this technique successfully in four eyes with opaque or severely traumatized corneas.
D ABSTRACT Das Ziel des DEWS-Unterausschusses für Defi nition und Klassifi kation war die Erarbei... more D ABSTRACT Das Ziel des DEWS-Unterausschusses für Defi nition und Klassifi kation war die Erarbeitung einer zeitgemäflen Defi nition des Trockenen Auges, die durch einen umfassenden Klassifi kationsrahmen gestützt wurde. Eine neue Defi nition des Trockenen Auges wurde entwickelt, um das aktuelle Verständnis der Erkrankung wiederzugeben, und der Ausschuss empfahl ein dreiteiliges Klassifi kationssystem. Der erste Teil ist ätiopathologisch ausgerichtet
The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical ... more The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical trials evaluating the effectiveness of histocompatibility matching in high risk keratoplasty patients. The antigen matching study (AMS) evaluated HLA matching in patients without circulating lymphocytotoxic antibody to HLA antigens and the cross-match study (CS) evaluated the effect of using cross-match-negative donors in patients with identified circulating lymphocytotoxic antibodies to HLA antigens. Sera from 510 patients considered for enrollment in the studies were screened preoperatively for the presence of anti-class I lymphocytotoxic antibodies (LA). The 42 patients (8%) found to have detectable LA entered the CS. The 468 patients found not to have detectable LA preoperatively entered the AMS. Fifteen of the 37 transplanted CS patients were found to have donor-specific anti-class I antibody (before or after surgery). These patients were also screened for anti-class II LA and 25 had anti-class II panel reactive antibody > or = 5%. Forty-nine of the 419 transplanted AMS patients (12%) were found to have produced anti-class I LA after surgery, and in 19 patients, antibody specificities were those of donor HLA antigens. There was a significant association between the number of mismatched class I antigens and the number of donor-specific LA produced. The production of LA by AMS patients was significantly associated with reaction episodes; eighty-two percent of patients (40 of 49) with LA had reaction, compared with 63% of patients (230 of 365) without LA (P = 0.02). Likewise, production of donor-specific LA was significantly associated with immune-mediated graft failure (P = 0.025). For CS patients, there was no correlation between the production of donor-specific anti-class I or nonspecific anti-class II antibodies and graft outcome. However, the CS patients had poorer graft survival than did AMS patients at 3 years (57% vs. 66%, P = 0.01). These data demonstrate that LA, especially directed against donor class I HLA antigens following corneal transplantation in high risk patients, are associated with immune graft rejection and can be an indicator of allograft rejection.
To report a new surgical technique to manage severe acute toxic epidermal necrolysis. Two interve... more To report a new surgical technique to manage severe acute toxic epidermal necrolysis. Two interventional case reports. Two patients. Case 1: A 6-year-old boy had severe toxic epidermal necrolysis develop after being treated with trimethoprim and sulfamethoxazole for chronic otitis media. Both eyes and eyelids were affected. He underwent bilateral lysis of symblepharon and all adhesions and bilateral amniotic membrane transplantation to the entire ocular surface except the cornea. Loss of eyelid skin required transplantation of amniotic membrane to all four eyelids and strips of amniotic membrane at the eyelid margins. Case 2: An 8-year-old girl with severe toxic epidermal necrolysis associated with mycoplasma pneumonia had bilateral, diffuse keratoconjunctivitis, diffuse corneal epithelial defects, and bilateral symblepharon. Amniotic membrane transplantation was performed bilaterally, using a symblepharon ring in the left eye. Amniotic membrane transplantation. Preservation of normal ocular and eyelid surfaces and prevention of blindness. Case 1: Thirty-six months after bilateral ocular surgery, there is no symblepharon, good ocular surface wetting, and an uncorrected bilateral vision of 20/20. Case 2: Amniotic membrane transplantation protected both ocular surfaces and prevented conjunctival contracture without adhesion of the eyelids to the ocular surface. The central vision was preserved. There was minimal peripheral corneal vascularization and mild conjunctival scarring of the tarsal conjunctival surface 34 months postoperatively. These are the first cases of acute toxic epidermal necrolysis treated with amniotic membrane transplantation and the first use of the procedure on external eyelid surfaces with good healing of the eyelids. This new treatment for acute toxic epidermal necrolysis preserves normal ocular and eyelid surfaces and may prevent blindness.
To determine patient tolerance and ocular surface staining characteristics of 1% lissamine green ... more To determine patient tolerance and ocular surface staining characteristics of 1% lissamine green versus 1% rose bengal solutions in patients with dry eye and in those with normal ocular surfaces by comparison of subjective sensation and objective staining scores. Twelve patients with keratoconjunctivitis sicca and eight subjects with no ocular surface disease recorded their symptoms on a graded scale (0-5) and the duration of symptoms after instillation of one drop of 1% lissamine green and 1% rose bengal on two different occasions in different order. Lissamine green and rose bengal staining patterns were recorded on a graded scale (0-4) by one of the authors. For patients with keratoconjunctivitis sicca mean sensation score with lissamine green (2.42) was significantly lower (P = 0.00006) than with rose bengal (4.58). The duration of symptoms was significantly longer (P = 0.0007) after rose bengal instillation as well. For subjects with no ocular surface disease, mean sensation score with lissamine green (1.375) was significantly lower (P = 0.01) than with rose bengal (2.5). In this group, duration of symptoms also was significantly longer (P = 0.001) after rose bengal instillation. In both groups, there was no difference in objective staining scores. Lissamine green is better tolerated than rose bengal by patients and is equally as effective as rose bengal in evaluating the ocular surface in keratoconjunctivitis sicca.
A review of 14 patients who underwent corneal transplantation after intravitreal silicone oil tam... more A review of 14 patients who underwent corneal transplantation after intravitreal silicone oil tamponade included an average follow-up of 28 months. Mean graft survival was 25 months (range, 2 to 61 months). Frequency of graft failure was 43% (6 of 14) with a mean occurrence at 14.5 months (range, 2 to 36 months). Allograft rejections occurred in four patients, two of whom progressed to graft failure. The frequency of graft failure was 25% (2 of 8) when silicone oil was removed at the time of keratoplasty compared with 67% (4 of 6) when silicone oil was retained.
We examined the effect of matching for HLA-A and B antigens on the success of corneal transplanta... more We examined the effect of matching for HLA-A and B antigens on the success of corneal transplantation in a single-center, prospective, masked study that began in March 1979. The study involved 97 consecutive recipients at high risk because of prior corneal graft rejection or serious vascularization of the native cornea. Donor corneas were selected on the basis of ABO-blood-group compatibility, a negative lymphocyte crossmatch, and optimal HLA-A and B matching; all clinical personnel were "masked" to the degree of HLA matching during the study. Among 38 patients receiving corneas with a good HLA match (two or more antigens), only 8 (21 percent) had graft rejection, as compared with 29 of 59 (49 percent) with a poor match (no or one antigen) (P less than 0.010). The mean (+/- SE) difference in rejection-free graft survival increased with time: 88.4 +/- 5.5 percent versus 73.5 +/- 5.9 percent at six months, and 80.1 +/- 7.5 percent versus 38.5 +/- 7.9 percent at two years. Cox multiple regression analysis, which included the HLA-A and B match and nine other potential confounding variables and risk factors also identified a significant (P less than 0.009) relative risk (4.6) of rejection reactions as well as irreversible graft rejection (P less than 0.016; relative risk, 11.2) with poor HLA-A and B matching. Our findings indicate that good HLA-A and B matching yields a significant long-term benefit in reducing the number of episodes of graft rejection and subsequent failure in high-risk recipients of corneal transplants.
The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical ... more The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical trials evaluating the effectiveness of histocompatibility matching in high risk keratoplasty patients. The antigen matching study (AMS) evaluated HLA matching in patients without circulating lymphocytotoxic antibody to HLA antigens and the cross-match study (CS) evaluated the effect of using cross-match-negative donors in patients with identified circulating lymphocytotoxic antibodies to HLA antigens. Sera from 510 patients considered for enrollment in the studies were screened preoperatively for the presence of anti-class I lymphocytotoxic antibodies (LA). The 42 patients (8%) found to have detectable LA entered the CS. The 468 patients found not to have detectable LA preoperatively entered the AMS. Fifteen of the 37 transplanted CS patients were found to have donor-specific anti-class I antibody (before or after surgery). These patients were also screened for anti-class II LA and 25 had anti-class II panel reactive antibody > or = 5%. Forty-nine of the 419 transplanted AMS patients (12%) were found to have produced anti-class I LA after surgery, and in 19 patients, antibody specificities were those of donor HLA antigens. There was a significant association between the number of mismatched class I antigens and the number of donor-specific LA produced. The production of LA by AMS patients was significantly associated with reaction episodes; eighty-two percent of patients (40 of 49) with LA had reaction, compared with 63% of patients (230 of 365) without LA (P = 0.02). Likewise, production of donor-specific LA was significantly associated with immune-mediated graft failure (P = 0.025). For CS patients, there was no correlation between the production of donor-specific anti-class I or nonspecific anti-class II antibodies and graft outcome. However, the CS patients had poorer graft survival than did AMS patients at 3 years (57% vs. 66%, P = 0.01). These data demonstrate that LA, especially directed against donor class I HLA antigens following corneal transplantation in high risk patients, are associated with immune graft rejection and can be an indicator of allograft rejection.
To evaluate the safety and efficacy of the removal of INTACS. Subgroup analysis from a nonrandomi... more To evaluate the safety and efficacy of the removal of INTACS. Subgroup analysis from a nonrandomized comparative interventional trial. Four hundred fifty-two patients with best spectacle-corrected visual acuity of 20/20 or better and myopia (1.0-3.5 diopters [D]) were enrolled in the U.S. Food and Drug Administration clinical trials of INTACS. Forty-six eyes among a total of 684 underwent INTACS removal. INTACS removal. Safety and efficacy of INTACS removal was assessed by comparison of results from preoperative and 3-month postremoval visits. Safety was assessed by maintenance of preoperative best spectacle-corrected acuity and induction of astigmatism (measured by manifest refraction). Efficacy was assessed by comparison of mean spherical equivalent measured by both manifest and cycloplegic refraction, as well as percentage of eyes within +/- 0.5 D and +/- 1.0 D of baseline values. A subset of 27 patients completed a prospective questionnaire assessing the frequency of six visual symptoms (glare, halos, double vision, photophobia, night vision difficulties, and fluctuating vision). Best spectacle-corrected visual acuity, manifest refraction, and cycloplegic refraction. Forty-one of 46 patients' eyes that had undergone INTACS removal had reached the 3-month postremoval visit. Of these eyes, 73% (30 of 41) had returned to within +/- 0.5 D and 97% (40 of 41) to within +/- 1.0 D of baseline spherical equivalent as measured by manifest refraction. With respect to astigmatism, 88% (36 of 41) had returned to within +/- 0.5 D and 100% (41 of 41) to within +/- 1.0 D of preoperative value. No patient had a loss of best spectacle-corrected acuity of more than 2 lines, with equal numbers of eyes having a loss or gain of 1 line (nine eyes) and 2 lines (one eye). For most eyes, INTACS removal was associated with a substantial reduction in the six types of visual symptoms; however, in some eyes (up to 15%) symptoms that had not been detected preoperatively were noted after INTACS removal. INTACS removal was not associated with a loss (> 2 lines) of best spectacle-corrected visual acuity or induction (> 1 D) of astigmatism or myopia. INTACS removal was associated with a reversal to preoperative values in most cases.
The pathogenesis of posterior polymorphous dystrophy was analyzed by immunohistologic methods. Se... more The pathogenesis of posterior polymorphous dystrophy was analyzed by immunohistologic methods. Sections of corneal buttons from two patients undergoing transplantation owing to posterior polymorphous dystrophy were stained with 2B4.14.1, a monoclonal antibody that reacts with human corneal endothelium, and with a cocktail of antihuman cytokeratin monoclonal antibodies that do not react with normal corneal endothelium. Single-stained sections revealed a variegated, intermittent staining pattern of antibody reactive and nonreactive cells. Double-stained sections revealed some cells that stained with only one of the antibodies and many cells that stained with both antibodies. The presence of cells staining positively for both 2B4.14.1 antigen and cytokeratins supports the hypothesis that the cytokeratin-expressing epithelial-like cells found in corneas with posterior polymorphous dystrophy arise via a metaplastic process in which the phenotype of endothelial cells becomes progressively abnormal.
As a first step to characterize human meibum and tear lipids, infrared spectroscopy was applied t... more As a first step to characterize human meibum and tear lipids, infrared spectroscopy was applied to characterize the molecular structure/conformation and packing of hydrocarbon chains. Temperature-induced phase transitions were fit to a sigmoid equation and were experimentally reproducible and were similar for multiple samples collected from the same person. No hysteresis was observed. Hydration of polar tear lipids increased their phase transition cooperativity, enthalpy and entropy. Hydrophobic interactions in meibum lipid (ML) were stronger than in tear-fluid lipids (TL), as reflected by the higher entropy and enthalpy of the gel to liquid crystalline phase transition of ML. The results of this study provide further evidence of the differences in the composition and structure of ML and TL. The conformational changes observed in the hydrocarbon chains of ML with temperature suggest that the observed therapeutic increased delivery of ML with eye lid heating could be related to the i...
A 33-year-old man had a unique lens capsular cyst that became clinically evident eight years afte... more A 33-year-old man had a unique lens capsular cyst that became clinically evident eight years after a penetrating ocular injury in which the lens capsule was disrupted. Microscopic examination indicated that the cyst may have arisen from displaced lens capsule and epithelial cells that became separated from the lens.
We have developed a series of temporary keratoprostheses that permit closed pars plana vitrectomy... more We have developed a series of temporary keratoprostheses that permit closed pars plana vitrectomy in eyes with abnormal corneas. These devices are placed into a trephined opening in the cornea, and provide a clear, stable view of the intraocular contents. Immediately after vitrectomy, the keratoprosthesis is replaced with a corneal graft. We have used this technique successfully in four eyes with opaque or severely traumatized corneas.
D ABSTRACT Das Ziel des DEWS-Unterausschusses für Defi nition und Klassifi kation war die Erarbei... more D ABSTRACT Das Ziel des DEWS-Unterausschusses für Defi nition und Klassifi kation war die Erarbeitung einer zeitgemäflen Defi nition des Trockenen Auges, die durch einen umfassenden Klassifi kationsrahmen gestützt wurde. Eine neue Defi nition des Trockenen Auges wurde entwickelt, um das aktuelle Verständnis der Erkrankung wiederzugeben, und der Ausschuss empfahl ein dreiteiliges Klassifi kationssystem. Der erste Teil ist ätiopathologisch ausgerichtet
The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical ... more The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical trials evaluating the effectiveness of histocompatibility matching in high risk keratoplasty patients. The antigen matching study (AMS) evaluated HLA matching in patients without circulating lymphocytotoxic antibody to HLA antigens and the cross-match study (CS) evaluated the effect of using cross-match-negative donors in patients with identified circulating lymphocytotoxic antibodies to HLA antigens. Sera from 510 patients considered for enrollment in the studies were screened preoperatively for the presence of anti-class I lymphocytotoxic antibodies (LA). The 42 patients (8%) found to have detectable LA entered the CS. The 468 patients found not to have detectable LA preoperatively entered the AMS. Fifteen of the 37 transplanted CS patients were found to have donor-specific anti-class I antibody (before or after surgery). These patients were also screened for anti-class II LA and 25 had anti-class II panel reactive antibody > or = 5%. Forty-nine of the 419 transplanted AMS patients (12%) were found to have produced anti-class I LA after surgery, and in 19 patients, antibody specificities were those of donor HLA antigens. There was a significant association between the number of mismatched class I antigens and the number of donor-specific LA produced. The production of LA by AMS patients was significantly associated with reaction episodes; eighty-two percent of patients (40 of 49) with LA had reaction, compared with 63% of patients (230 of 365) without LA (P = 0.02). Likewise, production of donor-specific LA was significantly associated with immune-mediated graft failure (P = 0.025). For CS patients, there was no correlation between the production of donor-specific anti-class I or nonspecific anti-class II antibodies and graft outcome. However, the CS patients had poorer graft survival than did AMS patients at 3 years (57% vs. 66%, P = 0.01). These data demonstrate that LA, especially directed against donor class I HLA antigens following corneal transplantation in high risk patients, are associated with immune graft rejection and can be an indicator of allograft rejection.
To report a new surgical technique to manage severe acute toxic epidermal necrolysis. Two interve... more To report a new surgical technique to manage severe acute toxic epidermal necrolysis. Two interventional case reports. Two patients. Case 1: A 6-year-old boy had severe toxic epidermal necrolysis develop after being treated with trimethoprim and sulfamethoxazole for chronic otitis media. Both eyes and eyelids were affected. He underwent bilateral lysis of symblepharon and all adhesions and bilateral amniotic membrane transplantation to the entire ocular surface except the cornea. Loss of eyelid skin required transplantation of amniotic membrane to all four eyelids and strips of amniotic membrane at the eyelid margins. Case 2: An 8-year-old girl with severe toxic epidermal necrolysis associated with mycoplasma pneumonia had bilateral, diffuse keratoconjunctivitis, diffuse corneal epithelial defects, and bilateral symblepharon. Amniotic membrane transplantation was performed bilaterally, using a symblepharon ring in the left eye. Amniotic membrane transplantation. Preservation of normal ocular and eyelid surfaces and prevention of blindness. Case 1: Thirty-six months after bilateral ocular surgery, there is no symblepharon, good ocular surface wetting, and an uncorrected bilateral vision of 20/20. Case 2: Amniotic membrane transplantation protected both ocular surfaces and prevented conjunctival contracture without adhesion of the eyelids to the ocular surface. The central vision was preserved. There was minimal peripheral corneal vascularization and mild conjunctival scarring of the tarsal conjunctival surface 34 months postoperatively. These are the first cases of acute toxic epidermal necrolysis treated with amniotic membrane transplantation and the first use of the procedure on external eyelid surfaces with good healing of the eyelids. This new treatment for acute toxic epidermal necrolysis preserves normal ocular and eyelid surfaces and may prevent blindness.
To determine patient tolerance and ocular surface staining characteristics of 1% lissamine green ... more To determine patient tolerance and ocular surface staining characteristics of 1% lissamine green versus 1% rose bengal solutions in patients with dry eye and in those with normal ocular surfaces by comparison of subjective sensation and objective staining scores. Twelve patients with keratoconjunctivitis sicca and eight subjects with no ocular surface disease recorded their symptoms on a graded scale (0-5) and the duration of symptoms after instillation of one drop of 1% lissamine green and 1% rose bengal on two different occasions in different order. Lissamine green and rose bengal staining patterns were recorded on a graded scale (0-4) by one of the authors. For patients with keratoconjunctivitis sicca mean sensation score with lissamine green (2.42) was significantly lower (P = 0.00006) than with rose bengal (4.58). The duration of symptoms was significantly longer (P = 0.0007) after rose bengal instillation as well. For subjects with no ocular surface disease, mean sensation score with lissamine green (1.375) was significantly lower (P = 0.01) than with rose bengal (2.5). In this group, duration of symptoms also was significantly longer (P = 0.001) after rose bengal instillation. In both groups, there was no difference in objective staining scores. Lissamine green is better tolerated than rose bengal by patients and is equally as effective as rose bengal in evaluating the ocular surface in keratoconjunctivitis sicca.
A review of 14 patients who underwent corneal transplantation after intravitreal silicone oil tam... more A review of 14 patients who underwent corneal transplantation after intravitreal silicone oil tamponade included an average follow-up of 28 months. Mean graft survival was 25 months (range, 2 to 61 months). Frequency of graft failure was 43% (6 of 14) with a mean occurrence at 14.5 months (range, 2 to 36 months). Allograft rejections occurred in four patients, two of whom progressed to graft failure. The frequency of graft failure was 25% (2 of 8) when silicone oil was removed at the time of keratoplasty compared with 67% (4 of 6) when silicone oil was retained.
We examined the effect of matching for HLA-A and B antigens on the success of corneal transplanta... more We examined the effect of matching for HLA-A and B antigens on the success of corneal transplantation in a single-center, prospective, masked study that began in March 1979. The study involved 97 consecutive recipients at high risk because of prior corneal graft rejection or serious vascularization of the native cornea. Donor corneas were selected on the basis of ABO-blood-group compatibility, a negative lymphocyte crossmatch, and optimal HLA-A and B matching; all clinical personnel were "masked" to the degree of HLA matching during the study. Among 38 patients receiving corneas with a good HLA match (two or more antigens), only 8 (21 percent) had graft rejection, as compared with 29 of 59 (49 percent) with a poor match (no or one antigen) (P less than 0.010). The mean (+/- SE) difference in rejection-free graft survival increased with time: 88.4 +/- 5.5 percent versus 73.5 +/- 5.9 percent at six months, and 80.1 +/- 7.5 percent versus 38.5 +/- 7.9 percent at two years. Cox multiple regression analysis, which included the HLA-A and B match and nine other potential confounding variables and risk factors also identified a significant (P less than 0.009) relative risk (4.6) of rejection reactions as well as irreversible graft rejection (P less than 0.016; relative risk, 11.2) with poor HLA-A and B matching. Our findings indicate that good HLA-A and B matching yields a significant long-term benefit in reducing the number of episodes of graft rejection and subsequent failure in high-risk recipients of corneal transplants.
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