Estimation of corneal endothelial pump function in long-term contact lens wearers.
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PURPOSE: To study the effects of long-term contact lens wear on morphologic and physiologic properties of corneal endothelial cells. METHODS: The endothelial permeability to fluorescein and the rate of corneal deswelling from hypoxia-induced edema were measured in 20 long-term (mean, 17+/-9 years; range, 5-33 years) contact lens wearers and 20 age-matched control subjects. From these data, the relative endothelial pump rate in each subject was estimated, based on the pump-leak hypothesis of corneal hydration control. Corneal autofluorescence and the aqueous humor flow rate were determined by fluorescein fluorophotometry. Images of corneal endothelial cells were recorded by using specular microscopy, and morphologic indices (cell density, coefficient of variation of cell area, percentage of hexagonal cells, and skewness) were determined. RESULTS: No statistically significant differences were found between the contact lens and control groups in endothelial permeability, corneal deswelling, relative endothelial pump rate ([mean +/- SD] 1.07+/-0.33 relative pump units versus 1.01+/-0.25 relative pump units; contact lens versus control; P = 0.57), and endothelial cell density. Contact lens wearers had a significantly higher aqueous humor flow rate (3.57+/-1.03 microl/min versus 2.77+/-0.51 microl/min; P = 0.005), coefficient of variation of cell area (0.35+/-0.09 versus 0.28+/-0.04; P = 0.006), and corneal autofluorescence (3.1+/-0.6 ng/ml versus 2.3+/-0.3 ng/ml fluorescein equivalents; P < 0.001) than did non-contact lens wearers. CONCLUSIONS: Despite the known effects of long-term contact lens wear on corneal endothelial morphometry, no effect on endothelial function was found. (+info)
Contact lens-induced infection--a new model of Candida albicans keratitis.
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PURPOSE: A model of experimental keratomycosis was established that mimics human disease in which the only fungi present are those that are actively growing within the cornea. METHODS: Dutch-belted rabbits received a subconjunctival injection of triamcinolone acetonide to one eye. One day later the epithelium was removed from the central cornea and a standardized inoculum of Candida albicans blastoconidia was placed on the corneal surface and covered with a contact lens. The lids were closed with a lateral tarsorrhaphy. After 24 hours, the lid sutures and contact lens were removed. Five days later the animals were killed, and their corneas were subjected to separate isolate recovery and histology studies. A group of similarly infected rabbits without corticosteroid injection served as controls. RESULTS: Both groups developed invasive corneal disease. Although isolate recovery was not significantly different from corticosteroid-treated rabbits compared with controls, fungal biomass was increased. Hyphal invasion was limited to the anterior cornea in control eyes, but penetrated deep stroma in most of the corticosteroid-treated rabbits. CONCLUSIONS: Invasive corneal disease can be established with a surface inoculum. Corticosteroid administration increased corneal penetration of hyphae. Quantitative isolate recovery is not a reliable measure of the fungal load within the cornea. (+info)
Clinical estimation of corneal endothelial pump function.
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PURPOSE: To develop a technique to estimate the corneal endothelial pump rate in human subjects. METHODS: Corneal hydration control is thought to be maintained by a pump-leak mechanism whereby the leak of solutes and fluid across the endothelial barrier into the stroma is, in the steady state, exactly balanced by the pumping of solutes and passive fluid transfer across the endothelium to the aqueous humor. Overall corneal hydration control can be measured from the rate at which the swollen cornea thins (deswells), and a measure of the leak can be obtained simultaneously from the endothelial permeability to fluorescein. From the pump-leak hypothesis, the deswelling rate is directly proportional to the pump rate and inversely proportional to the leak rate. The relative endothelial pump rate can be estimated as the product of the normalized deswelling rate and the normalized endothelial permeability. This procedure was used to obtain the relative endothelial pump rate in 41 patients with diabetes mellitus, 12 patients with long-term corneal transplants, 20 long-term wearers of contact lenses, and 19 normal volunteer subjects after the short-term administration of topical dorzolamide. RESULTS: The relative endothelial pump rate did not differ significantly from that of control subjects in diabetics, in contact lens wearers, and after dorzolamide administration, but was markedly decreased in the patients with corneal transplants, despite a reduction in permeability (reduced leak). CONCLUSIONS: This method allows the estimation of both the barrier and pump arms of corneal endothelial function and should be useful in the investigation of causes and mechanisms of functional endothelial insufficiency. (+info)
Rehabilitation of children with cataracts.
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Over a period of 10 years, 160 children with cataracts underwent operation at the University of Tennessee Medical Center, Memphis. The surgical, optical, and psychosocial rehabilitation of these patients was analyzed and studied. The optical rehabilitation included patients with glasses, intraocular lens implants, epikeratophakia, and contact lenses. Seventy three of these patients were chosen at random and reevaluated as to visual outcome, and 46 were subjected to a psychosocial test to evaluate their quality of life and their rehabilitation. Eighteen of these were also given a psychosocial test to evaluate the quality of life enjoyed by these children at an older age following treatment for the cataract. Surgical, optical, and psychosocial rehabilitation of such children is also discussed. This is the first report of the psychological evaluation of such children. The further needs of these children as they approach adulthood are discussed in detail. (+info)
Rapid improvement in the acuity of infants after visual input.
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Visual acuity was assessed in 28 human infants who had been deprived of all patterned visual input by cataracts in one or both eyes until they were treated at 1 week to 9 months of age. Immediately after treatment, acuity was no better than that of normal newborns. Acuity improved significantly over the next month, with some improvement apparent after as little as 1 hour of visual input. Unlike findings at older ages, the pattern of results was the same for eyes treated for monocular and for binocular deprivation. The results indicate that patterned visual input is necessary for the postnatal improvement of human visual acuity and that the onset of such input initiates rapid functional development. (+info)
Measurement of post-lens tear thickness.
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PURPOSE: A method to measure the tear film beneath a soft contact lens, referred to as post-lens tear thickness (PLTT), would have many applications to contact lens research. In this study a noninvasive technique for measuring the PLTT is presented. METHODS: The feasibility of measuring the tear layer by optical pachometry was first assessed using a model eye. The baseline corneal thickness (B) of both eyes of 21 subjects was measured, etafilcon-A ionic disposable soft contact lenses (58% water) were inserted, and the total thickness (T) of the cornea, contact lens, and PLTT were measured. After the pachometry readings the lenses were removed and their center thickness (C) determined. The PLTT was calculated using the equation: PLTT = T-(B+C). Two sets of measurements of T were performed at 15 and 25 minutes after lens insertion. The entire procedure was repeated at a second visit. RESULTS: The pachometry measurements of the small aqueous reservoir between the model eye and the lens closely matched those obtained by direct microscopic measurement. For human PLTT, the mean values (and 95% confidence intervals) for right eyes on visits 1 and 2 were 11 (8, 13) and 12 (10, 15) microm, respectively, and for left eyes were 12 (10, 15) and 11 microm (8, 14) microm, respectively. CONCLUSIONS: It is possible to measure the post-lens tear thickness using optical pachometry. The variability between repeated measurements suggests that with careful sample size planning, the technique is sufficiently precise to be useful in group assessments of PLTT. (+info)
Isoenzyme patterns and phylogenetic relationships in Acanthamoeba spp. isolated from contact lens containers in Korea.
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In order to refer to the basic information regarding the identification of isolates obtained from a contact lens container in Korea, the isoelectric focusing gel electrophoresis was employed to compare the isoenzyme band patterns among Acanthamoeba spp. including eight isolates and the simple pairwise dissimilarity analysis was carried out. For an alkaline phosphate development, isolate 7 and Acanthamoeba polyphaga showed homologous band patterns, and isolates 1, 2, and 3 showed the same patterns. For lactate dehydrogenase, similar patterns were observed in isolates 2 and 3. Isolates 3 and 5 showed homologous band patterns for malate dehydrogenase and glucose phosphate isomerase. For hexokinase, isolates 4, 7, and A, hatchetti showed the same band patterns. In others, a considerable number of interstrain polymorphisms was observed in nine isoenzyme band patterns. In Acanthamoeba group II, genetic distances among isolates 1, 2, 3, 4, and 5 ranged from 0.104 to 0.200. In comparison to A. castellanii, A. hatchetti, and A. polyphaga, genetic distances of isolates 7 and 8 were 0.254 and 0.219, respectively. In Acanthamoeba group III, including A. culbertsoni, A. healyi, and A. royreba, isolate 6 had genetic distances which ranged from 0.314 to 0.336. Finally, when comparing to the six reference Acanthamoeba, it was possible to classify isolates 1, 2, 3, 4, and 5, as genetically close-related species and as independent species group. Furthermore, isolates 6, 7 and 8 were identified as independent species as well. (+info)
Clinical course of hurricane keratopathy.
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BACKGROUND/AIMS: "Hurricane keratopathy" is the name given to the whorl pattern, highlighted with fluorescein, seen in situations where corneal epithelial cell turnover is exaggerated. Although the condition is well described, follow up data on patients with this condition and its sequelae have only been reported in corneal graft patients. The aim was to study the clinical course of hurricane keratopathy in corneal graft patients and contact lens wearers, and to document any sequelae of this condition. METHODS: Hurricane keratopathy, occurring in 20 eyes with corneal grafts and 16 eyes (six bilateral) wearing rigid gas permeable contact lenses, was studied and followed. The occurrence, pattern, progress, resolution, and residual effects of the whorls were noted. RESULTS: Hurricane keratopathy was noted to occur in grafts as previously reported and also in contact lens wearers, which has hitherto not been reported. The whorls usually appeared within the first 3 weeks postoperatively and persisted up to 4 months. A small epithelial defect (11.1%), heaped epithelial cells (5.6%), and a nebular grade opacity (2.8%), were the only significant sequelae noted at the epicentre of the whorls. Resolution occurred from the periphery towards the centre of the cornea. CONCLUSIONS: The whorl pattern is sustained as long as the stimulus for increased cell turnover is maintained. Once this stimulus is eliminated, the pattern tends to resolve spontaneously. (+info)