Retrocorneal Membrane Research Articles

Final Report on the Safety Assessment of Aluminum Silicate, Calcium Silicate, Magnesium Aluminum Silicate, Magnesium Silicate, Magnesium Trisilicate, Sodium Magnesium Silicate, Zirconium Silicate, Attapulgite, Bentonite, Fuller's Earth, Hectorite, Kaolin, Lithium Magnesium Silicate, Lithium Magnesium Sodium Silicate, Montmorillonite, Pyrophyllite, and Zeolite

This report reviews the safety of Aluminum, Calcium, Lithium Magnesium, Lithium Magnesium Sodium, Magnesium Aluminum, Magnesium, Sodium Magnesium, and Zirconium Silicates, Magnesium Trisilicate, Attapulgite, Bentonite, Fuller's Earth, Hectorite, Kaolin, Montmorillonite, Pyrophyllite, and Zeolite as used in cosmetic formulations. The common aspect of all these claylike ingredients is that they contain silicon, oxygen, and one or more metals. Many silicates occur naturally and are mined; yet others are produced synthetically. Typical cosmetic uses of silicates include abrasive, opacifying agent, viscosity-increasing agent, anticaking agent, emulsion stabilizer, binder, and suspending agent. Clay silicates (silicates containing water in their structure) primarily function as adsorbents, opacifiers, and viscosity-increasing agents. Pyrophyllite is also used as a colorant. The International Agency for Research on Cancer has ruled Attapulgite fibers >5 μm as possibly carcinogenic to humans, but fibers <5 μm were not classified as to their carcino-genicity to humans. Likewise, Clinoptilolite, Phillipsite, Mordenite, Nonfibrous Japanese Zeolite, and synthetic Zeolites were not classified as to their carcinogenicity to humans. These ingredients are not significantly toxic in oral acute or short-term oral or parenteral toxicity studies in animals. Inhalation toxicity, however, is readily demonstrated in animals. Particle size, fibrogenicity, concentration, and mineral composition had the greatest effect on toxicity. Larger particle size and longer and wider fibers cause more adverse effects. Magnesium Aluminum Silicate was a weak primary skin irritant in rabbits and had no cumulative skin irritation in guinea pigs. No gross effects were reported in any of these studies. Sodium Magnesium Silicate had no primary skin irritation in rabbits and had no cumulative skin irritation in guinea pigs. Hectorite was nonirritating to the skin of rabbits in a Draize primary skin irritation study. Magnesium Aluminum Silicate and Sodium Magnesium Silicate caused minimal eye irritation in a Draize eye irritation test. Bentonite caused severe iritis after injection into the anterior chamber of the eyes of rabbits and when injected intralamellarly, widespread corneal infiltrates and retrocorneal membranes were recorded. In a primary eye irritation study in rabbits, Hectorite was moderately irritating without washing and practically nonirritating to the eye with a washout. Rats tolerated a single dose of Zeolite A without any adverse reaction in the eye. Calcium Silicate had no discernible effect on nidation or on maternal or fetal survival in rabbits. Magnesium Aluminum Silicate had neither a teratogenic nor adverse effects on the mouse fetus. Female rats receiving a 20% Kaolin diet exhibited maternal anemia but no significant reduction in birth weight of the pups was recorded. Type A Zeolite produced no adverse effects on the dam, embryo, or fetus in either rats or rabbits at any dose level. Clinoptilolite had no effect on female rat reproductive performance. These ingredients were not genotoxic in the Ames bacterial test system. In primary hepatocyte cultures, the addition of Attapulgite had no significant unscheduled DNA synthesis. Attapulgite did cause significant increases in unscheduled DNA synthesis in rat pleural mesothelial cells, but no significant increase in sister chromosome exchanges were seen. Zeolite particles (<10 μm) produced statistically significant increase in the percentage of aberrant metaphases in human peripheral blood lymphocytes and cells collected by peritoneal lavage from exposed mice. Topical application of Magnesium Aluminum Silicate to human skin daily for 1 week produced no adverse effects. Occupational exposure to mineral dusts has been studied extensively. Fibrosis and pneumoconiosis have been documented in workers involved in the mining and processing of Aluminum Silicate, Calcium Silicate, Zirconium Silicate, Fuller's Earth, Kaolin, Montmorillonite, Pyrophyllite, and Zeolite. The Cosmetic Ingredient Review (CIR) Expert Panel concluded that the extensive pulmonary damage in humans was the result of direct occupational inhalation of the dusts and noted that lesions seen in animals were affected by particle size, fiber length, and concentration. The Panel considers that most of the formulations are not respirable and of the preparations that are respirable, the concentration of the ingredient is very low. Even so, the Panel considered that any spray containing these solids should be formulated to minimize their inhalation. With this admonition to the cosmetics industry, the CIR Expert Panel concluded that these ingredients are safe as currently used in cosmetic formulations. The Panel did note that the cosmetic ingredient, Talc, is a hydrated magnesium silicate. Because it has a unique crystalline structure that differs from ingredients addressed in this safety assessment, Talc is not included in this report.

Final Report on the Safety Assessment of Aluminum Silicate, Calcium Silicate, Magnesium Aluminum Silicate, Magnesium Silicate, Magnesium Trisilicate, Sodium Magnesium Silicate, Zirconium Silicate, Attapulgite, Bentonite, Fuller's Earth, Hectorite, Kaolin, Lithium Magnesium Silicate, Lithium Magnesium Sodium Silicate, Montmorillonite, Pyrophyllite, and Zeolite

This report reviews the safety of Aluminum, Calcium, Lithium Magnesium, Lithium Magnesium Sodium, Magnesium Aluminum, Magnesium, Sodium Magnesium, and Zirconium Silicates, Magnesium Trisilicate, Attapulgite, Bentonite, Fuller's Earth, Hectorite, Kaolin, Montmorillonite, Pyrophyllite, and Zeolite as used in cosmetic formulations. The common aspect of all these claylike ingredients is that they contain silicon, oxygen, and one or more metals. Many silicates occur naturally and are mined; yet others are produced synthetically. Typical cosmetic uses of silicates include abrasive, opacifying agent, viscosity-increasing agent, anticaking agent, emulsion stabilizer, binder, and suspending agent. Clay silicates (silicates containing water in their structure) primarily function as adsorbents, opacifiers, and viscosity-increasing agents. Pyrophyllite is also used as a colorant. The International Agency for Research on Cancer has ruled Attapulgite fibers >5 μm as possibly carcinogenic to humans, but fibers <5 μm were not classified as to their carcino-genicity to humans. Likewise, Clinoptilolite, Phillipsite, Mordenite, Nonfibrous Japanese Zeolite, and synthetic Zeolites were not classified as to their carcinogenicity to humans. These ingredients are not significantly toxic in oral acute or short-term oral or parenteral toxicity studies in animals. Inhalation toxicity, however, is readily demonstrated in animals. Particle size, fibrogenicity, concentration, and mineral composition had the greatest effect on toxicity. Larger particle size and longer and wider fibers cause more adverse effects. Magnesium Aluminum Silicate was a weak primary skin irritant in rabbits and had no cumulative skin irritation in guinea pigs. No gross effects were reported in any of these studies. Sodium Magnesium Silicate had no primary skin irritation in rabbits and had no cumulative skin irritation in guinea pigs. Hectorite was nonirritating to the skin of rabbits in a Draize primary skin irritation study. Magnesium Aluminum Silicate and Sodium Magnesium Silicate caused minimal eye irritation in a Draize eye irritation test. Bentonite caused severe iritis after injection into the anterior chamber of the eyes of rabbits and when injected intralamellarly, widespread corneal infiltrates and retrocorneal membranes were recorded. In a primary eye irritation study in rabbits, Hectorite was moderately irritating without washing and practically nonirritating to the eye with a washout. Rats tolerated a single dose of Zeolite A without any adverse reaction in the eye. Calcium Silicate had no discernible effect on nidation or on maternal or fetal survival in rabbits. Magnesium Aluminum Silicate had neither a teratogenic nor adverse effects on the mouse fetus. Female rats receiving a 20% Kaolin diet exhibited maternal anemia but no significant reduction in birth weight of the pups was recorded. Type A Zeolite produced no adverse effects on the dam, embryo, or fetus in either rats or rabbits at any dose level. Clinoptilolite had no effect on female rat reproductive performance. These ingredients were not genotoxic in the Ames bacterial test system. In primary hepatocyte cultures, the addition of Attapulgite had no significant unscheduled DNA synthesis. Attapulgite did cause significant increases in unscheduled DNA synthesis in rat pleural mesothelial cells, but no significant increase in sister chromosome exchanges were seen. Zeolite particles (<10 μm) produced statistically significant increase in the percentage of aberrant metaphases in human peripheral blood lymphocytes and cells collected by peritoneal lavage from exposed mice. Topical application of Magnesium Aluminum Silicate to human skin daily for 1 week produced no adverse effects. Occupational exposure to mineral dusts has been studied extensively. Fibrosis and pneumoconiosis have been documented in workers involved in the mining and processing of Aluminum Silicate, Calcium Silicate, Zirconium Silicate, Fuller's Earth, Kaolin, Montmorillonite, Pyrophyllite, and Zeolite. The Cosmetic Ingredient Review (CIR) Expert Panel concluded that the extensive pulmonary damage in humans was the result of direct occupational inhalation of the dusts and noted that lesions seen in animals were affected by particle size, fiber length, and concentration. The Panel considers that most of the formulations are not respirable and of the preparations that are respirable, the concentration of the ingredient is very low. Even so, the Panel considered that any spray containing these solids should be formulated to minimize their inhalation. With this admonition to the cosmetics industry, the CIR Expert Panel concluded that these ingredients are safe as currently used in cosmetic formulations. The Panel did note that the cosmetic ingredient, Talc, is a hydrated magnesium silicate. Because it has a unique crystalline structure that differs from ingredients addressed in this safety assessment, Talc is not included in this report.

Histopathological correlation of corneal diseases with optical coherence tomography.

To correlate the cross-sectional images of corneal diseases obtained by optical coherence tomography (OCT) with light microscopy (LM) to determine the corneal components represented in OCT images. In a prospective comparative tissue study clinicopathological correlations of six patients with pseudophakic bullous keratopathy ( n=3), advanced keratoconus ( n=1), persistent epithelial defect with corneal thinning ( n=1), and retrocorneal membrane ( n=1) were included. Immediately before a planned penetrating keratoplasty (PKP) noncontact slitlamp-adapted OCT of the cornea was performed. After PKP and following standard histological processing the specimens were examined under LM to compare qualitatively the morphology, and quantitatively the morphometry at selected corneal locations. The cross-sectional optical-reflectivity profiles enabled the reproducible morphological evaluation of the corneal structures and changes. Layers of relative high reflectivity corresponded to the anterior corneal surface and internal stromal layers. In contrast, the deeper corneal epithelial layer demonstrated relative low reflectivity by OCT. An increase in light reflectivity corresponded to corneal scarring, irregularities of the corneal lamellae, and deposition of basal membrane material. Low signal intensity was particularly due to fluid accumulations and shadowing. The most prominent changes were caused by corneal scars or edematous tissue. The morphometric analysis with OCT revealed, in this study, thickness measurements ranging from 31 to 902 micro m. Although the mean OCT thickness values were up to 9% ( P=0.014) higher than those derived from LM, there was a significant positive correlation (r=0.94; P<0.001) between corneal OCT and the light-microscopic measurements. Noncontact slitlamp-adapted corneal OCT revealed a good correlation with histological sections. The differences noted were partly related to shrinking processes during preparation. Thus, with certain limitations, OCT allows a non-invasive optical biopsy of pathological structures in corneal diseases.

Retrocorneal Membrane After Penetrating Keratoplasty

Retrocorneal membranes after penetrating keratoplasty (PKP) is a well known complications, resulting from unintentional retention of the host Descemet's membrane (DM), or donor DM detachment. We describe for the first time the formation of a retrocorneal inflammatory membrane that mimics donor DM detachment or retained recipient DM, and discuss the differential diagnosis of a retrocorneal membrane after PKP. Two patients who underwent PKP and subsequently developed a retrocorneal membrane are described. In both patients' eyes a retrocorneal membrane was observed immediately following penetrating keratoplasty. While the first patient's membrane persisted for 33 months in the presence of a clear graft, the second patient's membrane disintegrated and dissolved within two weeks following treatment with topical steroids. The first case describes a patient with retained Descemet's membrane, while in the second case, it turned out that the retrocorneal membrane was actually an inflammatory membrane.

Connective Tissue Growth Factor in Retrocorneal Membranes and Corneal Scars

We studied the localization and distribution of connective tissue growth factor (CTGF) in corneal scar tissue and membranes using in situ hybridization in 8 corneas from keratoplasty and 4 normal corneas. Identification of the cells was done with immunohistochemistry for SM-α-actin, vimentin, and Lu5. CTGF mRNA was found in activated corneal fibroblasts in 7 of 8 scars, 7 of 8 retrocorneal membranes and 2 subepithelial membranes, whereas the control corneas showed no CTGF mRNA expression. Vimentin was positive in all scars, retrocorneal and subepithelial membranes, SM-α-actin in 7 of 8 scars and 6 of 8 retrocorneal membranes. These results suggest that CTGF plays a crucial role in corneal wound healing and membrane formation.

Retrocorneal membrane with myofibroblasts after perforating injury: an immunohistochemical and ultrastructural study of 11 cases.

Retrocorneal membranes (RCMs) are sometimes present after perforating corneal injury, including failed corneal grafts. This study was performed to understand the origin and cellular composition of these RCMs. Eleven cases of fibrous RCM associated with perforating injury and ulceration were studied by light and electron microscopy. Monoclonal antibodies against vimentin, actin, and alpha-smooth muscle actin (SMA) were used for immunohistochemical analysis. Retrocorneal membranes varied in thickness, extent, and cellularity. There was invariably a direct connection between RCM and wound scar through a gap in Descemet's membrane. Eight RCM and three scars of perforating wounds showed actin- or SMA-positive, vimentin-positive, spindle-shaped cells consistent with myofibroblasts. Electron microscopy showed fibroblasts and myofibroblasts in RCM. Descemet's membrane was often wrinkled in proximity to RCM with myofibroblasts. The scar tissue in corneal wounds is an apparent source of RCM components after perforating corneal injury, extending through gaps in Descemet's membrane. Contractile myofibroblasts are present in some RCMs and may be responsible for wrinkling of Descemet's membrane.

Characterization of epithelial downgrowth by confocal microscopy

A 43-year-old white woman with a history of multiple ocular surgeries, including 4 penetrating keratoplasties, developed a concentric retrocorneal membrane at the graft periphery in the right eye. A white-light, tandem, scanning confocal microscope using a 24 X/0.60 contact objective was used to examine the right eye in vivo. At the endothelial layer, confocal microscopic images similar to corneal epithelial cells were detected at the graft periphery. Unlike normal endothelial cells, the imaged cells demonstrated easily recognizable nuclei.

Transplantation of cultured adult human or porcine corneal endothelial cells onto human recipients in vitro. Part II: Evaluation in the scanning electron microscope.

To evaluate the morphology of endothelial monolayers, which have been regrafted onto the denuded Descemet's membrane, with scanning electron microscopy (SEM). Material derived from each of the experimental groups described in part I of this investigation was evaluated in the current study. Recipient corneas, denuded of their native endothelium by mechanical, chemical, or physical debridement, were examined to assess the effectiveness of each technique in killing and removing cells. Porcine or human donor corneal endothelial cells maintained in monolayer culture for up to 10 passages then were seeded onto the denuded Descemet's membranes of recipients in the absence or presence of fibroblast growth factor (FGF). The monolayers thereby established were examined in the SEM, and the morphologic status of individual cells compared with that manifested in normal human donor corneas maintained for 4 weeks in organ culture (reference control). Isolated and cultured human keratocytes regrafted onto the denuded Descemet's membranes of recipient corneas served as nonendothelial control specimens. Tissue was processed for examination in the SEM according to standard techniques. Each of the three methods used to strip recipient corneas of their native endothelium was effective and elicited no gross structural damage to Descemet's membrane. Some small focal defects within this latter layer were, however, observed, these being encountered at higher frequency after mechanical debridement than after chemical or physical stripping. Porcine or human endothelial cells seeded onto the denuded Descemet's membranes of recipient corneas formed stable monolayers. The morphologic status of regrafted cells corresponded to that manifested in monolayer cultures before seeding, porcine ones always being more differentiated than their human counterparts. Poorly differentiated human endothelial cells had a slender, elongated, fibroblast-like appearance, whereas more highly differentiated ones manifested broad, flat, polygonal profiles. Monolayers covered the entire corneal surface and impinged to a variable degree onto the trabecular meshwork, at which juncture cells always assumed a less well-differentiated morphology. FGF consistently effected an increase in differentiation status, and as this became augmented, the capacity of monolayers to violate the corneal-trabecular meshwork border was correspondingly repressed. Seeded keratocytes formed dense, multilayered sheaths, resembling retrocorneal membranes, across the entire corneal surface, trabecular meshwork, and iris root. The surface characteristics of the constituent cells were quite distinct from those manifested by endothelial cells, even the least well-differentiated ones. Regrafting of human corneal endothelial cells onto the denuded Descemet's membranes of recipients resulted in the formation of stable monolayers. Because the morphologic status of seeded cells closely mimicked that manifested in monolayer cultures before transplantation, it may be anticipated that efforts to refine and optimize culturing conditions would yield improvements in this parameter after regrafting. If these expectations can be realized, then the possibility of successfully establishing a "new" and functional endothelium on recipient corneas destined for clinical grafting may well be brought to fruition in the not-too-distant future.

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers.

This is a retrospective histopathological study of archive slides from the Comparative Ocular Pathology Laboratory of Wisconsin from 1981 to 1997. Reports on eyes or ocular contents from 2176 dogs were reviewed. Five-hundred and thirty out of 2176 (24%) of the cases had a clinical or histologic diagnosis of glaucoma. Twenty-five out of 530 (5%) of the canine cases of glaucoma were in Golden Retrievers. Thirteen out of 25 (52%) of the Golden Retriever cases of glaucoma had iridociliary cysts. Iridociliary cysts in Golden Retrievers may lead to the development of glaucoma. Histologically all 13 of the cases of glaucoma and iridociliary cysts had large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber. The following histologic features were also present: thick walled cysts containing hyaluronic acid (8/13; 62%), a solid cellular proliferation (2/13; 15%), a retrocorneal membrane associated with a defect in Descemet's membrane (7/13; 54%), iris bombé (5/13; 38%), a preiridal fibrovascular membrane (4/13; 31%), hemorrhage (4/13; 31%), a cellular membrane on the anterior lens surface (6/13; 46%), retinal detachment (5/13; 38%), peripheral anterior synechia (5/13; 38%), and posterior synechia (6/13; 46%). Complete follow up was obtained on 11/13 (85%) of the Golden Retrievers with glaucoma and iridociliary cysts. Two/11 (18%) of the dogs were euthanized due to intractable glaucoma. Eight/13 (62%) of the dogs had problems in the other eye. The other eye was diagnosed with uveitis 5/11 (45%), glaucoma 2/11(18%), pigment in the anterior chamber 3/11 (27%), and iridociliary cysts 4/11 (36%).

Transplantation of congenitally opaque corneas

AIMSTo assess retrospectively the prognosis and complications of corneal grafting for congenital opacities.METHODSFifty eight eyes of infants and young children with congenital corneal opacities were studied retrospectively. Preoperative diagnoses included...

Lensification of the Posterior Corneal Surface: An Unusual Proliferation of Lens Epithelial Cells

Abnormal proliferation of lens epithelial cells occurs in a variety of situations, such as anterior and posterior subcapsular cataracts and secondary cataract formation. The purpose of this report is to document an unusual occurrence of diffuse proliferation of lens epithelium and capsule along the posterior corneal surface. The authors performed penetrating keratoplasty to remove an edematous and scarred cornea is a 19-year-old Indian man. Three years previously, the patient had undergone penetrating keratoplasty and extracapsular cataract extraction to treat a nonhealing corneal ulcer. The keratectomy specimen was processed for conventional light microscopy. Five-micrometer sections were stained with hematoxylin-eosin and the periodic acid-Schiff methods. Intraoperatively, the eye was found to be aphakic with an intact posterior capsule. The iris tissue consisted of fibrotic, pigmented remnants adherent to the peripheral cornea for 360 degrees, closing the angle and capsular fornix. Histologically, cataractous lens material including proliferated lens epithelial cells and capsule diffusely lined the posterior corneal surface along a thick retrocorneal fibrous membrane. This case represents a new category of lens epithelial cell proliferation or migration or both that covers entirely the posterior corneal surface. The authors believe the term lensification is appropriate for the condition described herein.

Histological changes and wound healing response following noncontact holmium: YAG laser thermal keratoplasty

To evaluate acute histological changes and the induced wound healing response in corneal tissue following noncontact holmium:YAG laser thermal keratoplasty (LTK).LTK using 10 pulses and a range of radiant energies was performed on 3 human corneas one day prior ro their removal at penetrating keratoplasty. Rabbit corneas were treated with 10-pulse and 5-pulse LTK and followed for up to 3 months. Tissues were studies with light and transmission electron microscopy and immunohistochemistry.The amount of acute tissue injury increased with increasing pulse radiant energy. In human corneas, changes in the irradiated zones included epithelial cell injury and death loss of fine filamentous structure in Bowman's layer, disruption of stromal lamallae, and keratocyte injury and death. In the rabbit corneas, similar acute changes were noted. By 3 weeks, epithelial hyperplasia and stromal contraction were present. Wound healing in the rabbit corneas included repair of the epithelial attachment complex, keratocyte activation, synthesis of type I collagen, partial restoration of stromal keratan sulfate and type VI collagen, and retrocorneal membrane formation. Compared to 10-pulse treatments, 5-pulse treatments produced less acute tissue injury and had more rapid restoration of normal stromal architecture.Noncontact LTK produces acute epithelial and stromal tissue changes and in rabbit corneas stimulates a brisk wound healing response. These changes could contribute to postoperative regression of induced refractive correction. Further work is required to determine if reductions in the magnitude of acute tissue injury and induced wound healing response will enhance the efficacy and stability of LTK.

Stromal fibroblasts are associated with collagen IV in scar tissues of alkali-burned and lacerated corneas

PURPOSE. Corneal wound healing frequently leads to the formation of opaque scar tissue. We examined whether stromal fibroblastic cells of injured corneas express collagen IV and contributes to the formation of a basal lamina-like structure. METHODS. Rabbits were anesthetized, and central corneal alkali burn (8 mm in diameter; 1 M NaOH, 1 min) or laceration (8 mm long) were produced. The injured corneas, which had healed for 1, 7, 21 and 45 days, were subjected to histological and immunohistochemical studies with goat anti-collagen IV antibodies, using light and electron microscopy, and in situ hybridization with an antisense digoxigenin-labeled riboprobe of collagen a1(IV) mRNA. For comparison, twenty-day-old fetal corneas were subjected to immunohistochemical study and transmission electron microscopy (TEM). RESULTS. TEM examinations revealed that the stromal collagenous matrix was organized in orthogonal lamellae during corneal development, whereas that of alkali-burned cornea, which had healed for 3 weeks, was disorganized. The stroma of twenty-day-old fetal cornea was not labeled by the anti-collagen IV antibodies. In contrast, one week after injury, specific collagen IV immunostaining was detected in the injured stroma. As the healing proceeded (21–45 days), the antibodies reacted with fibroblastic cells and the extracellular matrix of scar tissues located in the anterior portion of alkali-burned corneas, as well as the posterior portion of lacerated corneas. The middle portion of the stromal tissues was weakly labeled by the anti-collagen IV antibodies with the exception of the blood vessel wall. Immuno-electron microscopic study showed that collagen IV and fibronectin were closely associated with the fibroblastic cells. In situ hybridization demonstrated that epithelial and endothelial cells and fibroblastic cells in the wounded corneal stroma and retro-corneal membrane expressed a1(IV) mRNA, whereas in normal corneas the expression of a1(IV) mRNA was limited to epithelial and endothelial cells. CONCLUSIONS. The enhanced expression of collagen IV by the fibroblastic cells in the stroma of injured corneas is consistent with the notion that they may contribute to the formation of basal lamina-like structures in injured corneas.

Histologic changes and wound healing response following 10-pulse noncontact holmium:YAG laser thermal keratoplasty.

Noncontact holmium:YAG laser thermal keratoplasty (Ho:YAG LTK) is a promising new technology for correction of hyperopia and astigmatism. We studied the acute histologic changes and wound healing response following Ho:YAG LTK performed with treatment parameters encompassing those used in clinical studies. We performed 10-pulse noncontact Ho:YAG LTK on three human corneas 1 day before their removal at penetrating keratoplasty and on six New Zealand white rabbit corneas followed for up to 3 months. Tissues were studied with light and transmission electron microscopy and immunohistochemistry. The amount of acute tissue injury increased according to the pulse radiant energy. In human corneas, changes in the irradiated zones included epithelial cell injury and death, loss of fine filamentous structure in Bowman's layer, disruption of stromal lamellae, and keratocyte injury and death. In the rabbit corneas, similar acute changes were noted. By 3 weeks, epithelial hyperplasia and stromal contraction were present. Wound healing in the rabbits included repair of the epithelial attachment complex, keratocyte activation, synthesis of type I collagen, partial restoration of stromal keratan sulfate and type VI collagen, and retrocorneal membrane formation. Noncontact Ho:YAG LTK produces acute epithelial and stromal tissue changes and in rabbit corneas stimulates a brisk wound healing response.

The results of penetrating keratoplasty for keratoconus

At the Department of Ophthalmology, University Hospital in Lund, Sweden, keratoconus is the most common indication for penetrating keratoplasty. We studied 77 keratoplasties performed on keratoconic eyes between 1989-1991. Postoperative corrected visual acuity was better than or equal to 0.5 in 65 eyes (84.4%), and 30 eyes (39%) had visual acuity of 1.0. The mean postoperative astigmatism was 3.75 D with a range of 0-12.5 D. Eight patients underwent relaxing incision with satisfactory results in 6 patients. Graft rejection was observed in 6 eyes (7.8%). The most serious complication seen in our group of patients was a retrocorneal fibrous membrane that developed in one patient.

In vivo evaluation of a collagen corneal allograft derived from rabbit dermis.

This study evaluates epithelialization, clarity, intraocular inflammation, and fibroblast ingrowth of a collagen corneal allograft derived from rabbit dermis. Dermal collagen fibers were dispersed intact and chemically modified to make them soluble. The allografts consisted of a fibrous, opaque peripheral zone and a central clear area. Twelve New Zealand white rabbits underwent penetrating keratoplasty with implantation of an allograft. The grafts were evaluated daily for clarify, anterior segment inflammation, and extent of reepithelialization with a slit-lamp microscope. Epithelialization of the fibrous peripheral zone of the graft ranged from 0% to 90%. The central clear area did not epithelialize in any of the animals. Fibroblasts migrated into the peripheral zone in all eyes. Complications included ulceration of the central clear area in two eyes. There was no ulceration or leakage at the graft-host interface and no synechia, fibrous, or inflammatory retrocorneal membranes in any of the eyes. Our study is the first to describe the method of modifying dermal type I collagen into a clear corneal allograft. Survival of the corneal collagen allograft beyond 1 month may be limited by several factors including lack of epithelialization of the central clear area.

Ursachen der irreversiblen Transplantateintrübung im ersten Jahr nach perforierender Keratoplastik

The reasons for corneal graft failure during the first postoperative year were examined. The functional and morphological parameters were recorded prospectively on 210 eyes with penetrating keratoplasty postoperatively after 1, 4 and 12 months. 1 month postoperatively one graft, 4 months after surgery 5 grafts, and 12 months after keratoplasty 15 grafts had failed. The reasons were: 3 cases of irreversible rejection, 4 retrocorneal membranes, 4 persisting corneal erosions with ulceration, and 4 stromal infections (3 Herpes, 1 Akanthamoeba). During the first postoperative year, in our patients corneal graft rejection was a rare event accounting for 3 of 15 graft failures with an incidence of 1.4% in all grafts studied.

Complications associated with endocapsular balloon implantation in rabbit eyes

After phacoemulsifying the lens in six rabbit eyes through a 1.3 mm anterior capsule opening, we implanted a silicone balloon in the capsular bag and filled it with liquid silicone. The eyes were enucleated nine to 21 months postoperatively, embedded in paraffin, stained with toluidine blue, and examined by stereoscopic and light microscopy. We looked at the postoperative complications primarily. All balloons were securely fixated within the capsule. Surface wrinkles were observed in two balloons. The injected silicone remained transparent. None of the lens capsules was completely transparent, although all remained relatively clear. Retrocorneal membranes were produced in one eye in which the silicone leaked.

Real‐time confocal microscopy of keratocyte activity in wound healing after cryoablation in rabbit corneas

AbstractA modified tandem scanning confocal microscope was used for real‐time in vivo examination of the rabbit cornea following a cryogenic injury. The corneas of New Zealand white rabbits were frozen with a probe that had been cooled by immersion in liquid nitrogen, effectively destroying keratocytes in a central 5 mm diameter zone throughout the total thickness of the cornea. In these eyes, keratocyte repopulation and corneal stromal wound healing proceeded similarly to that which occurs after epikeratophakia, a refractive surgical procedure designed to change the curvature and optical power of the cornea. In epikeratophakia, a cryolathed donor corneal stroma lenticule is sutured onto the bare stroma of the recipient cornea. The collagen tissue lenticule is repopulated by keratocytes (corneal fibroblasts) that migrate in from the host cornea. In our study, the confocal microscope permitted sequential, noninvasive examination of the corneal stroma in the treated animals. Necrosis of the keratocytes, followed by activation of the remaining viable cells in the corneal periphery, was observed in the first 2 to 3 days after cryo injury. A fine stromal fibrous network was seen to develop; in three eyes, this network progressed to the development of a retrocorneal fibrous membrane and dense stromal fibrosis, both of which resulted in significant loss of corneal clarity. Our results suggest that the confocal microscope may be a valuable tool to provide much needed information on wound healing processes at the cellular level after corneal surgery and injury.

Intraokulare Komplikationen nach schweren Verätzungen - Häufigkeit und chirurgische Behandlung

The prognosis of severe eye burns is determined by the area of the injured conjunctiva and the damage of the cornea. Furthermore the extension of damage to intraocular structures influences the clinical course and the surgical management. The clinical course of 66 patients with 90 severely burnt eyes in the time from January 1985 to December 1993 were examined with special regard to primary and secondary intraocular complications. In 62 (68.9%) eyes, the whole anterior eye segment was burnt, while in 28 (31.1%) eyes the damage was limited to the cornea and limbus. A cataract occurred in 23 (25.6%) eyes short time after the burn and an early secondary glaucoma in 14 (15.6%) eyes. In the further clinical course, 41 (45.6%) eyes developed a secondary cataract and 20 (22.2%) eyes a late secondary glaucoma. Within 3 months after the burn, 18 eyes were treated with a Tenon plasty, a penetrating keratoplasty and a cataract extraction. In 12 eyes a cataract extraction was combined with a penetrating keratoplasty more than one year after the injury. In the other cases cataract extraction and keratoplasty were performed in separate operations. In 8 eyes intraocular lenses were implanted. In 15 (16.6%) eyes secondary glaucoma had to be treated by trabeculectomy or by the implantation of a von Denffer implant. Penetrating keratoplasty was performed in 55 eyes, 35 of them were unsuccessful as a consequence of graft rejection or increasing vascularisation. One third of the patients achieved a long-term visual acuity of 0.1 and more. After severe burn a high rate of intraocular complications has to be expected. The surgical management of such eyes differs from standard procedures. Principally, all devitalized tissue of the anterior chamber like fibrinous and retrocorneal membranes should be excised in an early stage after the burn. Penetrating keratoplasties and extraction of the cataractous lens should be performed in a combined procedure. The implantation of an intraocular lens is limited to a few special cases.