1/11. Confocal microscopy in cornea guttata and fuchs' endothelial dystrophy.AIMS: To report the appearances of cornea guttata and fuchs' endothelial dystrophy from white light confocal microscopy. methods: Seven eyes of four consecutive patients with cornea guttata were prospectively examined. Of the seven eyes, three also had corneal oedema (Fuchs' dystrophy). In vivo white light tandem scanning confocal microscopy was performed in all eyes. Results were compared with non-contact specular microscopy. RESULTS: Specular microscopy was precluded by corneal oedema in one eye. In the remaining six eyes, it demonstrated typical changes including pleomorphism, polymegathism, and the presence of guttae appearing as dark bodies, some with a central bright reflex. In all seven eyes, confocal microscopy revealed the presence of round hyporeflective images with an occasional central highlight at the level of the endothelium. Changes in cell morphology and size were readily appreciated. CONCLUSION: By comparison with specular microscopy, the hyporeflective images with an occasional central highlight seen on confocal microscopy are consistent with the presence of guttae. Confocal microscopy may confirm the diagnosis of cornea guttata and fuchs' endothelial dystrophy by demonstrating the presence of guttae. This technique is especially valuable in cases of corneal oedema, where specular microscopy may fail to visualise the endothelium. However, specular microscopy should remain the method of choice to evaluate the endothelium, principally because it is easier to use.- - - - - - - - - - ranking = 1keywords = edema (Clic here for more details about this article) |
2/11. fuchs' endothelial dystrophy: a fresh look at an aging disease.The increasing number or corneal and intraocular surgeries performed together with longer life expectancy, elevates the risk for developing symptomatic Fuchs' endothelial dystrophy (FED). This article reviews the current understanding of FED, and, in addition, a case of early FED is presented clinically and histopathologically. Two FED corneas from one patient were examined histopathologically using an established histological protocol for light and electron microscopy. FED is an inherited autosomal dominant corneal endothelial disorder with incomplete penetrance that is up to 3 times less likely to develop in men. Treatment options are primarily palliative while surgical intervention routinely involves a penetrating keratoplasty. In this disease process the endothelium produces excessive amounts of basement membrane material of an abnormal composition resulting in the formation of a posterior collagenous layer. Extreme accumulations of this material created mushroom-like formations, guttae, projecting into the anterior chamber. The endothelial cells were extremely thinned over the guttae, to the point where the cells may provide little more than barrier function. Despite a presumably compromised endothelial pump the corneas appeared relatively free of edema clinically and histopathologically. However, some edematous pockets deep in the basal epithelial layer were present suggesting that epithelial involvement occurs at an early stage in the disease. An early diagnosis of FED will help patients and surgeons to better elect optimal surgical timing and procedures. The current trend is to intervene surgically before the patient reaches the painful end-stage. Interestingly, in the case examined, the endothelium presumably provided only a barrier function over large areas with an apparently reduced contribution from the endothelial fluid pump and yet the corneas remained relatively clear. Future research may confirm that decompensation occurs only when complete endothelial coverage is lost. If the endothelial barrier function is more important to corneal transparency than the endothelial pump function in FED, then the relative combination of these two functions in the normal cornea should also be reassessed.- - - - - - - - - - ranking = 0.66666666666667keywords = edema (Clic here for more details about this article) |
3/11. Differential diagnosis of corneal oedema assisted by in vivo confocal microscopy.The purpose of this study was to demonstrate microstructural differences between clinically similar, but aetiologically different, cases of corneal oedema in four subjects. In vivo confocal microscopy highlighted oedema of the basal epithelium, prominent nerve-keratocyte interactions, and typical 'epithelialization' of the endothelium in a case of iridocorneal endothelial syndrome; however, a similar microstructural appearance was observed in a case of presumed herpetic disciform keratitis. The latter diagnosis was subsequently revised on this basis. Confocal examination of fuchs' endothelial dystrophy demonstrated oedema of the basal epithelium, prominent wing cells, anterior stromal alterations, fibrosis of Descemet's membrane and a typical 'strawberry' appearance of the endothelium. In contrast, in vivo microstructural examination of bilateral keratoconus with hydrops confirmed oedema mainly involving the epithelium and anterior stroma. In vivo confocal microscopy allows the clinician to observe the living cornea at a microstructural level and to better diagnose and differentiate borderline or unusual cases of corneal oedema.- - - - - - - - - - ranking = 3keywords = edema (Clic here for more details about this article) |
4/11. Use of infant donor tissue for endokeratoplasty.Endokeratoplasty using an infant donor cornea was performed in an 81-year-old man with fuchs' endothelial dystrophy, corneal decompensation, and a history of cystoid macular edema in the left eye. The patient reported minimal discomfort after surgery, and the best spectacle-corrected visual acuity improved from 20/400 to 20/100 by the second postoperative month with resolution of the corneal edema. Endokeratoplasty using an infant cornea is a viable alternative to penetrating keratoplasty for corneal endothelial decompensation, and infant corneas may provide a new and potentially healthier source of tissue for corneal transplantation.- - - - - - - - - - ranking = 728.04658961296keywords = corneal edema, edema (Clic here for more details about this article) |
5/11. Corneal decompensation after laser in situ keratomileusis in fuchs' endothelial dystrophy.PURPOSE: To report corneal decompensation after laser in situ keratomileusis (LASIK) in a patient with fuchs' endothelial dystrophy.methods: Observational case report. RESULTS: A 47-year-old woman with cornea guttata without symptoms or findings of corneal edema had uneventful LASIK for -5.50 -0.50 x 150 in the right eye and -4.00 -1.25 x 170 in the left eye. Postoperatively, she developed corneal edema, with significant loss of best-corrected visual acuity in both eyes. Preoperative corneal thickness was 587 microm in the right eye and 549 microm in the left eye, measured by ultrasound pachymetry. These readings were 550 and 560 microm on day 67 postoperatively. Endothelial cell counts showed means of 1209 and 1661 cells/mm2 in the right and left eyes, respectively. CONCLUSION: Caution is suggested when considering LASIK in eyes with severe cornea guttata.- - - - - - - - - - ranking = 1455.4265125593keywords = corneal edema, edema (Clic here for more details about this article) |
6/11. Potential complications of ocular surgery in patients with coexistent keratoconus and fuchs' endothelial dystrophy.PURPOSE: To describe the potential complications of cataract and refractive surgery in patients with fuchs' endothelial dystrophy (FED) and keratoconus. DESIGN: Retrospective case series. PARTICIPANTS: Eight patients with FED and keratoconus in a large university group practice. methods: We reviewed the clinical and topographic findings of 8 patients (15 eyes) with FED and keratoconus. Clinical examination, corneal topography, specular microscopy were done, and sequential central corneal thickness (CCT) was obtained. Follow-up ranged from 1 month to 6 years. MAIN OUTCOME MEASURES: Findings of keratoconus and FED in preoperative evaluation. RESULTS: Five patients had concomitant cataracts; 3 had refractive errors and sought surgical correction. Cataract surgery was performed on 3 of 5 patients (5 eyes). LASIK was performed on one eye of 3 patients. Of 5 eyes that underwent cataract extraction, 4 had blurry vision after surgery. The interval between the surgical procedure and onset of symptoms ranged from 1 month to 4 years. The causes of decreased vision after cataract surgery were corneal edema and/or corneal ectasia. The CCT readings ranged from 426 to 824 microm. One of 4 symptomatic eyes underwent penetrating keratoplasty. The CCTs of 3 patients (6 eyes) who presented with refractive error ranged from 507 to 565 microm. One eye had undergone an attempted LASIK procedure resulting in a lost cap. corneal topography and specular microscopy showed the coexistence of keratoconus and FED, and the patients were advised against having LASIK surgery. CONCLUSIONS: Corneal thinning caused by keratoconus and concurrent increase in corneal thickness caused by FED may combine to normalize the corneal pachymetry readings; disease severity may be underestimated, which may lead to unexpected postoperative visual outcomes. Routine use of preoperative topography and specular microscopy may help to avert potential surgical complications.- - - - - - - - - - ranking = 727.71325627963keywords = corneal edema, edema (Clic here for more details about this article) |
7/11. fluorescein angiography of soft contact lens induced vascularization in penetrating keratoplasty.Soft contact lenses after penetrating keratoplasty have become more popular as improved materials with high water content and high oxygen permeability have become available. However, aphakic patients who have undergone penetrating keratoplasty seem to be at high risk for development of graft vascularization when extended wear soft lenses are used for optical correction. This report, to our knowledge, is the first to use corneal fluorescein angiography to study contact lens induced vascularization. Corneal fluorescein angiography, in two cases, showed that vascularization was often more extensive than clinically apparent. Further, these "new" vessels, in both cases, were shown to be "leaky." This great degree of leak contributed to graft edema in both and possibly, in one case, to graft rejection. These findings suggest that care in fitting and careful follow-up is necessary in any graft patient fit with an extended wear lens and that delicate or problem patients may be better aided with other forms of optical correction. Further, this report shows the value of corneal fluorescein angiography as a useful tool in the study of vascularization of the cornea from any cause.- - - - - - - - - - ranking = 0.33333333333333keywords = edema (Clic here for more details about this article) |
8/11. Fuchs' corneal dystrophy. A clinicopathologic study of the variation in corneal edema.Corneal buttons from six patients with Fuchs' dystrophy had varying degrees of clinical edema measured in most cases by preoperative optical or ultrasonic pachymetry. These were sectioned in the operating room so that histologic correlations could be made. Histologically, marked thickening of Descemet's membrane and abnormal corneal endothelium corresponded to areas of severe clinical edema and were usually located in the central and paracentral regions. Descemet's membrane displayed multiple prominent guttata of varying size and shape, either facing the anterior chamber, or buried within multilaminar Descemet's membrane. In some corneas, aggregates of 10 nm fibrils were seen at the edges of guttata, corresponding to areas that stained for oxytalan fibrils. The endothelium was attenuated underlying the guttata. Clinical edema was not present unless accompanied by marked thickening of Descemet's membrane with multiple guttata and attenuation of corneal endothelium. The peripheral cornea was relatively clear clinically and showed minimal histologic changes.- - - - - - - - - - ranking = 2911.8530251185keywords = corneal edema, edema (Clic here for more details about this article) |
9/11. Optometric management of Fuchs's endothelial dystrophy.Fuchs's endothelial dystrophy interferes with removal of fluid from the cornea by the endothelium. It progresses through stages of corneal guttata, corneal edema, bullous keratopathy, vascularization, and scarring, and complications such as glaucoma or infection. The optometrist can detect this disorder and manage its early stages as well as provide counseling and proper referral. This paper includes a case study and a discussion of the course and treatment of this disease.- - - - - - - - - - ranking = 727.71325627963keywords = corneal edema, edema (Clic here for more details about this article) |
10/11. Specular microscopic and histologic observations in nonguttate corneal endothelial degeneration.Six phakic patients with unilateral corneal edema and clinically normal-appearing fellow eyes were examined with specular microscopy and found to have endothelial pleomorphism and reduced cell counts in the nonedematous cornea. None of these patients had any previous eye disease, trauma, inflammation, or surgery. Clinically unrecognized endothelial disease was proposed as a cause for the unilateral corneal edema and was verified by light and electron microscopic studies in five patients. These pathologic findings vary somewhat from those found in Fuchs' dystrophy and may represent either a variant or a form of endothelial cell degeneration of as yet undetermined etiology. Our studies suggest that this condition is not detectable in the nonedematous cornea by standard high magnification biomicroscopy and requires the use of the clinical specular microscope to confirm the diagnosis in suspected cases.- - - - - - - - - - ranking = 1456.0931792259keywords = corneal edema, edema (Clic here for more details about this article) |
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