1/37. Lasiodiplodia theobromae as a cause of keratomycoses.Four cases of human keratitis caused by the tropical fungus Lasiodiplodia theobromae have been encountered in Miami, florida bringing to 8 the number of cases reported in the world literature. Two of the ulcers were mild. Three patients recovered without severe impairment of vision after topical polyene treatment, but 1 patient with a severe ulcer required therapeutic keratoplasty after 11 days of topical natamycin. Histopathology revealed fungus deep in the cornea, invading Descemet's membrane. L. theobromae appeared to have collagenase activity in vitro. Inoculation of L. theobromae into the corneas of rabbits produced progressive ulcers. The fungus was endemic in Miami on home grown and imported bananas. Polyene antimycotic antibiotics were fungicidal for L. theobromae in vitro. thiabendazole was effectively fungistatic but varied in fungicidal effect. clotrimazole and miconazole were only incompletely fungistatic. Of 7 strains of L. theobromae tested, 4 were relatively resistant to 5-flurocytosine.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/37. Hypopyon after repeated transplantation of human amniotic membrane onto the corneal surface.OBJECTIVE: The authors describe a localized probable immunoreaction after repeated transplantation of amniotic membrane (AM) onto the corneal surface. DESIGN: Interventional case report. INTERVENTION: Amniotic membrane was transplanted onto the corneal surface of a 78-year-old female with a deep trophic corneal ulcer resulting in temporary epithelial closure. A second and finally third amniotic membrane transplantation (AMT) was performed because of recurrent ulcerations. All three AMs were obtained from the same donor. RESULTS: The first transplantation of the AM was without complication. However, a hypopyon developed 2 days after the second and 2 days after the third AMT, but the patient responded immediately to topical and systemic corticosteroids. CONCLUSIONS: Immunologic, toxic, and hypersensitivity effects could have contributed to the hypopyon iritis that appeared after the second and third AMT, but not after the initial transplantation. In case of a repeated AMT, the use of AM from different donors may help to minimize the risk of an immediate postoperative intraocular inflammation.- - - - - - - - - - ranking = 7keywords = membrane (Clic here for more details about this article) |
3/37. Multilayered amniotic membrane transplantation for severe ulceration of the cornea and sclera.PURPOSE: To examine the efficacy of amniotic membrane transplantation in the treatment of deep corneal and scleral ulcers. patients: A total of 11 patients were recruited for this study: four patients (four eyes) with corneal perforation, five patients (five eyes) with a deep corneal ulcer and descemetocele, and two patients (two eyes) with a scleral ulcer. methods: Ulcers were treated by amniotic membrane transplantation. Separate amniotic membranes were transplanted as material to fill the stromal layer (amniotic membrane filling), as a basement membrane (amniotic membrane graft), and as a wound cover (amniotic membrane patch). After surgery, all cases were treated with artificial tears, autologous serum drops, antibiotic eyedrops, topical corticosteroids, and sodium hyaluronate eyedrops. RESULTS: Eight eyes (72.7%) healed with epithelialization in 16.5 /- 8.0 days (range, 7 to 29 days), with five and three eyes showing corneal epithelialization and conjunctival epithelialization, respectively. A persistent epithelial defect was noted in one eye with corneal ulcer after limbal allograft transplantation for a chemical burn and in two eyes with corneal ulcers as a complication of rheumatoid arthritis. CONCLUSION: Multilayered amniotic membrane transplantation may be effective for the treatment of deep ulceration of the cornea and sclera. In some eyes with total corneal limbal dysfunction or autoimmune disorders, amniotic membrane transplantation alone is not effective.- - - - - - - - - - ranking = 13keywords = membrane (Clic here for more details about this article) |
4/37. The role of matrix metalloproteinases in ulcerative keratolysis associated with perioperative diclofenac use.OBJECTIVE: To investigate the role of matrix metalloproteinases (MMPs) in the pathogenesis of ulcerative keratolysis associated with topical use of generic diclofenac preoperatively and postoperatively. To characterize the inflammatory response of the cornea in this case of ulcerative keratolysis. DESIGN: Case report with clinicopathologic correlation. MAIN OUTCOME MEASURES: Corneal culture for microbial growth. Clinical and histopathologic examinations including routine histolopathologic, immunofluorescent, and immunohistochemical studies. RESULTS: Microscopic examination of the corneal button disclosed fibrinous material with neutrophils and mononuclear inflammatory cells. The corneal epithelial basement membrane was irregularly thickened and patchy. Immunohistochemical staining detected weak staining of MMP-1 and a strong presence of MMP-8 in the epithelium. MMP-8 and 9 were also present in areas of leukocytic infiltration. MMP-2 appeared in a few stromal cells. macrophages and leukocytes were the predominant infiltrating cells. CONCLUSIONS: A nonspecific inflammatory response occurred in this case of ulcerative keratolysis. Corneal epithelial cells are capable of secreting MMP-1 and 8 and may participate in the stromal degradation and repair process of the ulcerative keratolysis associated with topical nonsteroidol antiinflammatory use.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
5/37. Amniotic membrane transplantation in the management of shield ulcers of vernal keratoconjunctivitis.PURPOSE: To report our experience with amniotic membrane transplantation in the management of severe shield ulcers. DESIGN: Retrospective, interventional, noncomparative case series. PARTICIPANTS: Four patients (seven eyes) with grade 2 (ulcer with opaque base) and grade 3 (plaquelike lesions) shield ulcers not responding to steroid therapy with or without surgical debridement. INTERVENTION: Amniotic membrane transplantation with stromal side down was performed after meticulous debridement of the ulcer. MAIN OUTCOME MEASURES: Healing of the ulcer with no epithelial defect. RESULTS: The ulcers healed with disintegration or retraction of the membrane in all patients within 2 weeks. CONCLUSIONS: Amniotic membrane transplantation in combination with debridement is an effective surgical modality in the management of severe shield ulcers. Further studies are warranted to confirm the efficacy of amniotic membrane transplantation in the management of shield ulcer and its correct position in the treatment algorithm.- - - - - - - - - - ranking = 9keywords = membrane (Clic here for more details about this article) |
6/37. Progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate (0.02%).PURPOSE: To report a case of progressive ulcerative keratitis related to the use of topical chlorhexidine gluconate 0.02%. methods: A 45-year-old woman was treated for presumed acanthamoeba keratitis with chlorhexidine gluconate 0.02% and propamidine 0.1% eyedrops. RESULTS: After using the chlorhexidine and propamidine eyedrops for 8 weeks, the patient developed a near total loss of the corneal epithelium and a progressive ulcerative keratitis, which eventually required penetrating keratoplasty. Histopathologic examination of the corneal button showed ulceration and loss of Bowman's membrane, massive loss of keratocytes with apparent apoptosis, and loss of the endothelial cells with inflammatory cells adherent to the remaining cells. These histopathologic findings are similar to those seen in Hibiclens keratopathy. Hibiclens contains chlorhexidine 4% with a detergent. No organisms were seen in sections stained with modified Ziehl-Neelsen, gram, Grocott, or periodic acid-Schiff, and immunohistochemistry showed no significant findings. CONCLUSION: We think that the topical use of chlorhexidine gluconate 0.02% may have resulted in a progressive ulcerative keratitis in our patient.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
7/37. Histologic findings after amniotic membrane graft in the human cornea.OBJECTIVE: To describe the histopathologic findings in the human cornea several months after a stromal amniotic membrane graft. To show the clinicopathologic correlation after the graft in two cases with different follow-up times. DESIGN: Two interventional case reports with clinicopathologic correlation. PARTICIPANTS: Two patients with neurotrophic corneal ulcer unresponsive to medical treatment (one with stromal vascularization and the other without stromal vascularization). INTERVENTION: Amniotic membrane graft was performed in both patients to treat the neurotrophic ulcer. Three and 7 months after amniotic membrane grafting, a penetrating keratoplasty was needed, and the removed corneas were analyzed. MAIN OUTCOME MEASURES: Clinical and histopathologic examinations, including routine histopathologic and immunohistochemical studies. RESULTS: Complete epithelialization was observed on histologic examination over the basement membrane of the amniotic membrane graft. The amniotic membrane was slowly reabsorbed in the cornea without stromal vascularization with no inflammatory reaction produced. In the cornea that had stromal vascularization the amniotic membrane was rapidly reabsorbed because of the presence of abundant inflammatory cells. Once reabsorbed, the amniotic membrane was replaced by new fibrotic stroma, that was different from that found in the rest of the cornea but that helped to maintain corneal thickness. CONCLUSIONS: The amniotic membrane graft allows for correct epithelialization in cases of neurotrophic corneal ulcer. Once the amniotic membrane is reabsorbed, it is replaced by a new fibrotic stroma, which can reduce corneal transparency. In corneas that have no stromal vascularization, the graft may remain in the stroma for many months, compromising corneal transparency during this period.- - - - - - - - - - ranking = 14keywords = membrane (Clic here for more details about this article) |
8/37. Amniotic membrane grafts for nontraumatic corneal perforations, descemetoceles, and deep ulcers.PURPOSE: To describe the clinical outcome of amniotic membrane transplantation (AMT) for nontraumatic corneal perforations, descemetoceles, and deep ulcers. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-four eyes of 33 consecutive patients operated on for nontraumatic corneal perforations or descemetoceles at four academic departments of ophthalmology. Associated autoimmune disorders included rheumatoid arthritis (n = 6), stevens-johnson syndrome (n = 3), ocular cicatricial pemphigoid (n = 2), systemic lupus erythematosus (n = 1), and one eye with Mooren's ulcer, as well as neurotrophic, or exposure keratopathy (n = 10), postinfectious nonhealing ulcers (n = 6), and postsurgery (n = 5). INTERVENTION: Three or four layers of amniotic membrane (AM) were applied over the ulcer bed and anchored with 10-0 nylon interrupted or running sutures. A large AM piece was used as a patch to cover the entire corneal surface. MAIN OUTCOME MEASURES: Formation of anterior chamber depth, epithelialization of the AM grafts, and stability of the corneal stromal thickness. RESULTS: The mean follow-up period was 8.1 /- 5.7 (ranging from 2-23) months. A successful result was observed in 28 of 34 eyes (82.3%). Of the successful cases, 23 eyes needed one AMT procedure, whereas 5 eyes needed two procedures to achieve a successful result. In five eyes, a subsequent definitive surgical procedure such as penetrating keratoplasty or lid surgery was needed. Failure was observed in six eyes with rheumatoid arthritis, neurotrophic keratopathy, or graft melting. CONCLUSIONS: AMT is an effective method for managing nontraumatic corneal perforations and descemetoceles. It can serve as either a permanent therapy or as a temporizing measure until the inflammation has subsided and a definitive reconstructive procedure can be performed. This treatment option is also beneficial in those countries where corneal tissue availability is limited.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
9/37. Toxic eosinophil granule protein deposition in corneal ulcerations and scars associated with atopic keratoconjunctivitis.PURPOSE: Recurrent or persistent corneal erosions and ulcerations are typical complications of atopic keratoconjunctivitis. Toxic eosinophil granule proteins such as major basic protein (MBP) and eosinophil cationic protein (ECP) may be involved in this pathogenetic process. This study was designed to demonstrate the presence of toxic eosinophil granule proteins in corneal tissue from a patient with corneal complications of atopic keratoconjunctivitis. DESIGN: Observational case report. methods: Three corneal buttons of a patient with atopic keratoconjunctivitis associated ulcerations or scarring were examined by light microscopy and by immunofluorescence technique. RESULTS: A linear deposition of eosinophil granular substance was detected subepithelially above Bowman's membrane in all corneal buttons. Indirect immunofluorescence identified this material as MBP and ECP. The deposits were not limited to the area of ulceration, but were also found underneath intact corneal epithelium. Multiple eosinophils were present in the upper corneal stroma. Normal corneas and negative control sections of the pathologic buttons revealed only minimal nonspecific staining at the surface of the epithelium. CONCLUSIONS: Both MBP and ECP are known to affect human corneal epithelial cell viability and morphology in vitro. Moreover, MBP was shown to inhibit epithelial migration and protein synthesis. These toxic eosinophil proteins may also be responsible for corneal instability, recurrent and persistent corneal epithelial defects and ulcerations in patients with atopic keratoconjunctivitis.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
10/37. Amniotic membrane transplantation for corneal perforation related to vitamin a deficiency.corneal perforation is one of the most vision-threatening consequences of vitamin a deficiency. Amniotic membrane transplantation was performed in a 36-year-old man who presented with bilateral corneal ulcers. There was a small, sharply demarcated superficial ulcer with crevices of surrounding keratinized epithelium converging on the ulcer and minimal infiltration at the inferior periphery of the right cornea. A 3-mm perforation on a 9 x 7-mm area of stromal melting was noticed in the left cornea. The serum vitamin A level was 14.0 microg/dL (normal, 24.57 to 105.71 microg/dL) at presentation. A biopsy of the right corneal epithelium was performed to confirm the diagnosis. Multilayered amniotic membrane transplantation with debridement of the necrotic corneal stroma was performed on the left cornea. In addition to systemic vitamin A replacement, topical antibiotics and lubricants were also administered. The cornea ulcers healed in 10 days along with the restoration of the serum vitamin A level. The visual acuity improved from 20/250 to 20/20 in the right eye and from light perception to hand movement in the left eye at 3 months. Amniotic membrane transplantation could save eyes with corneal perforation related to vitamin a deficiency before reconstructive surgeries, such as penetrating keratoplasty, are necessary.- - - - - - - - - - ranking = 7keywords = membrane (Clic here for more details about this article) |
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