Aims-This study was designed to investigate the therapeutic potential of excimer laser for recurrent painful erosions in patients not suited to treatment with penetrating keratoplasty. Methods-Phototherapeutic keratectomy (PTK) with the excimer laser was performed prospectively on a series of 13 eyes of 12 patients with recurrent corneal erosions in connection with bullous keratopathy of varied aetiology. The main complaint of the patients before the treatment was frequent attacks of pain. The patients selected either refused corneal grafting or could not for a variety of reasons expect to profit visually from an operation. The treatment was performed with the MEL 60 Aesculap Meditec excimer laser using either a spot mode (five cases), a scanning mode (three cases), or a combination of both (five cases). Results-All patients responded well to the treatment, and the pain subsided after a couple of weeks. In five cases (38/5%) a second treatment was necessary because of persistent pain, which was, however, much less than before the initial treatment.
Unobstructed vision requires a particular refractive index of the lens, a measure based on the organization of the structural proteins within the differentiated lens cells. To ensure an intact lens structure, homeostasis within the lens cells is indispensable. Alterations of the lens structure result in opacity and lead to cataract. Renal glucosuria is defined by elevated glucose level in the urine without hyperglycemia and without evidence of morphological renal anomalies. In a Swiss family with autosomal dominant juvenile cataract, microcornea, and renal glucosuria, we have identified a nonsense mutation in a member of the carboxylic acid transporter family SLC16. The underlying gene defect in SLC16A12 resides within a 3 cM region on chromosome 10q23.13 defined by linkage mapping of this phenotype. We found tissue-specific variability of SLC16A12 transcript levels in control samples, with high expression in the eye and kidney, the two organs affected by this syndrome. This report demonstrates biological relevance of this solute carrier. We hypothesize that SLC16A12 is important for lens and kidney homeostasis and discuss its potential role in age-related cataract.
To compare the accuracy of Goldmann tonometry with that of the Tono-Pen(R) in measuring intraocular pressure (IOP) after photorefractive keratectomy (PRK). Eye Clinic, Cantonal Hospital, Lucerne, Switzerland.Thirty-five eyes (25 patients) had PRK for a mean myopia of -6.2 diopters +/- 2.6 (SD). Intraocular pressure (IOP) measurements were performed first with the Goldmann tonometer and then with the Tono-Pen in 2 corneal locations: centrally in the usual manner and temporally. For the temporal measurements, the patient was directed to gaze nasally as the tonometer was placed perpendicular to the temporal portion of the cornea and with the rim of the tonometer positioned just inside the limbus of the cornea. Subsequently, similar measurements were made with the Tono-Pen. Measurements were performed before and 1 and 3 months after PRK. Preoperative IOPs measured centrally and temporally were similar. After PRK, the central pressure readings with the Goldmann tonometer and the Tono-Pen were between 1.8 and 2.3 mm Hg lower than those measured temporally. The differences were statistically significant (P <.0001). Central corneal pressure readings obtained with either the Goldmann tonometer or the Tono-Pen after myopic PRK are inaccurate. Measurements over the temporal part of the cornea are likely more reliable.
We evaluated the effects of astigmatic keratotomy performed in the host cornea to treat astigmatism after penetrating keratoplasty. In 11 patients with high post-keratoplasty astigmatisms (mean 9.02 diopters [D]; range 5.5 to 17.4 D), an arcuate keratotomy was performed in the host cornea. The mean incision depth was 575 mum (range 500 to 600 mum). The refractive data were analyzed using the Alpins method for vector analysis. The mean keratometric cylinder decreased to 3.41 D (range 0.9 to 5.3 D). The mean surgically induced astigmatism achieved was 7.3 +/- 3.89, with a mean correction index of 0.82 +/- 0.34. No microperforations were observed, and neither graft decompensation nor rejection occurred. Astigmatic keratotomy performed in the host cornea was a safe procedure to reduce post-keratoplasty astigmatism. The procedure offers the potential for correction of the astigmatism and has satisfactory predictability.
Sixteen eyes of eight rabbits were randomised to either mitomycin C or Balanced Salt Solution (BSS) application after photorefractive keratectomy (PRK). Regular examinations of wound healing and haze were performed with the slit lamp. The animals were killed between 1 and 26 weeks after treatment, and the corneas examined by light and electron microscopy. While the grade of haze showed no relevant differences between the two groups, scar tissue was found histologically in the mitomycin group in only 1 of 8 corneas compared with 5 of 8 in the BSS group. A marked reduction in keratocytes in all mitomycin-treated corneas and a normal density of keratocytes in the BSS group was observed. Mitomycin reduced the number of keratocytes in the treated corneas, leading to less scar formation but not to a reduction in haze. Since no morphological correlate has been found, haze remains unexplained in the mitomycin-treated corneas.
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