Purpose We sought to characterize the long-term outcomes and complications of subconjunctival triamcinolone acetonide injection (STI) for non-necrotizing, non-infectious anterior scleritis. Design Retrospective, interventional, noncomparative, multi-center study. Participants Sixty-eight eyes of 53 patients from nine participating hospitals in the United States, Singapore, and Australia. Only eyes with 6 or more months of follow-up were included. Intervention Subconjunctival injection of 2 to 40 mg of triamcinolone acetonide was administered to eyes with non-necrotizing, non-infectious anterior scleritis. Main Outcome Measures Resolution of signs and symptoms; time to recurrence of scleritis; side effect profile. Results Median follow-up was 2.3 years (range 6 months to 8.3 years). Sixty-six eyes (97.0%) experienced improvement of signs and symptoms after one injection. Twenty-four months after a single injection, 67.6% of eyes remained recurrence-free, while at 48 months, 50.2% were recurrence-free. 55.0% of patients who had adverse effects from systemic medications were off all systemic medications at last follow-up; 55.0% of patients who were on systemic medications at the time of first triamcinolone acetonide injection were off prednisone and immunosuppressants at this time; 76.2% of patients still needing systemic agents had associated systemic disease. Fourteen eyes (20.6%) had ocular hypertension not requiring intraocular pressure (IOP)-lowering therapy. Two eyes (2.9%) were treated with topical IOP-lowering agents alone while two needed surgical intervention for glaucoma. None developed scleral necrosis or melt. Conclusions This retrospective, international study carried out at nine hospitals suggests that STI can treat non-necrotizing, non-infectious anterior scleritis with side effects limited to elevated IOP in a few patients. Though no cases of scleral melt or necrosis were observed, we cannot definitively conclude that this may not occur after STI. Intraocular pressure should be closely monitored after STI. STI may be useful as adjuvant therapy or to decrease systemic medication burden.
SFRP1 is highly upregulated in the epithelium of these KC patients, suggesting a role in the pathogenesis and progression of keratoconus. Future investigations are required to establish if SFRP1 may be a potential marker of KC progression or if manipulation of its expression can be used to therapeutic effect in this disease.
We were quite surprised, and also concerned, to note that a patient given the proposed Northern European panacea for prevention of endophthalmitis following cataract surgery 1 (that is, intracameral cefuroxime) developed bilateral postoperative endophthalmitis. 2 This occurred 4 days after bilateral cataract surgery performed at the same sitting.A recent editorial 3 stated that the major risk factors for the development of postoperative endophthalmitis included corneal incisions, age (especially older than 80 years), and loss of posterior capsule integrity, which would allow direct access of bacteria into the vitreous. Further, it was recognized that there are essentially 2 opportunities for bacteria to enter the eye during cataract surgery: at the time of surgery and in the early postoperative period before epithelialization of an unsutured wound. This leads to the notion that sutured corneal incisions may reduce the risk for developing endophthalmitis in the postoperative period.In a laboratory model using India ink, Taban et al. 4 demonstrated that aqueous aspirates from 3 eyes with sutureless clear corneal incisions had increased spectrophotometric readings (P!.01). This was in contrast to the readings from aspirates in eyes with sutured corneal incisions, which showed no increase in absorbance level from baseline. This demonstrates that ingress of India ink occurs through sutureless clear corneal incisions, representing the potential passage of microorganisms into the eye.In sutureless cataract surgery, wound sealing is generally achieved by stromal hydration at the completion of the case. However, some evidence suggests that the wound is compromised when closure is not reinforced with suturing. Vasavada et al. 5 demonstrated in routine cataract surgery that wounds sealed by stromal hydration allowed ingress of trypan blue into the anterior chamber. Notably, trypan blue was detected in the anterior chamber within 2 minutes of stromal hydration. A recent study by Praveen et al. 6 confirmed this finding in 3 phacoemulsification techniques; the ingress was worst with bimanual phacoemulsification. Herretes et al. 7 reported ingress of blood-tinged fluid into the anterior chamber after the incisions were sealed by stromal hydration. These results have led to the conclusion that clear corneal incisions may not always be self-sealing.
We investigated the expression of the secreted frizzled-related proteins (SFRPs) in keratoconus (KC) and control corneas. KC buttons (∼8 mm diameter) (n = 15) and whole control corneas (n = 7) were fixed in 10% formalin or 2% paraformaldehyde and subsequently paraffin embedded and sectioned. Sections for histopathology were stained with hematoxylin and eosin, or Periodic Acid Schiff’s reagent. A series of sections was also immunolabelled with SFRP 1 to 5 antibodies, visualised using immunofluorescence, and examined with a Zeiss LSM700 scanning laser confocal microscope. Semi-quantitative grading was used to compare SFRP immunostaining in KC and control corneas. Overall, KC corneas showed increased immunostaining for SFRP1 to 5, compared to controls. Corneal epithelium in all KC corneas displayed heterogeneous moderate to strong immunoreactivity for SFRP1 to 4, particularly in the basal epithelium adjacent to cone area. SFRP3 and 5 were localised to epithelial cell membranes in KC and control corneas, with increased SFRP3 cytoplasmic expression observed in KC. Strong stromal expression of SFRP5, including extracellular matrix, was seen in both KC and control corneas. In control corneas we observed differential expression of SFRP family proteins in the limbus compared to more central cornea. Taken together, our results support a role for SFRPs in maintaining a healthy cornea and in the pathogenesis of epithelial and anterior stromal disruption observed in KC.
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