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Ocular media
Published in Fiona Rowe, Visual Fields via the Visual Pathway, 2016
These may be anterior (epithelial), stromal, posterior or ecstatic (keratoconus). They are often progressive and bilateral conditions affecting one of the layers of cornea. Anterior dystrophies can be due to recurrent erosions. Stromal dystrophies involve accumulation of deposits in the stromal layer, e.g. granular, macular and lattice dystrophies. Posterior dystrophies involve Descemet’s membrane and the endothelium, e.g. corneal guttata. Corneal dystrophy may be secondary to systemic disease, e.g. Fuchs dystrophy.
Combined Cataract and Glaucoma Surgery
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Arvind Neelakantan, Mary Fran Smith, Maher M. Fanous, Mark B. Sherwood
During the preoperative evaluation of a patient with cataract and glaucoma, the question of whether to do phacoemulsification alone or a combined cataract and glaucoma procedure is considered. One approach is to make this decision based on the number of medications the patient requires preoperatively for glaucoma control, modified by optic nerve and visual field appearance as well as by the patient’s life expectancy. For example, a patient requiring few medications might do well with phacoemulsification alone or with minimally invasive glaucoma surgery (MIGS) combined with phacoemulsification. However, if the patient is young and already has advanced nerve and field changes, a combined phacotrabeculectomy might be the better choice. Close attention should be paid to the status of the corneal endothelium and the integrity of the zonules at this evaluation. This is particularly important in glaucoma patients, such as those with irido-corneal endothelial syndrome, Fuchs’ dystrophy, or pseudoexfoliation. If a MIGS procedure is being considered, preoperative gonioscopy is essential to first confirm an open angle and also to ensure angle landmarks, such as trabecular meshwork and scleral spur, are clearly identified. The preoperative evaluation is also a good opportunity to judge the extent of pupillary dilation. Eliciting a prior history of systemic alpha-1 blocker use for benign prostatic hypertrophy helps anticipate the possible occurrence of intraoperative floppy iris syndrome (IFIS).
Targeting the integrated stress response in ophthalmology
Published in Current Eye Research, 2021
Hsiao-Sang Chu, Cornelia Peterson, Albert Jun, James Foster
Fuchs endothelial corneal dystrophy, a disorder of the corneal endothelium that is characterized by loss of endothelial cells and abnormalities of Descemet’s membrane, may result in progressive corneal edema.69,70 Enlargement of rough ER of endothelial cells has been demonstrated in Fuchs dystrophy specimens. Meanwhile, significantly higher peIF2α and CHOP expression were quantified in Fuchs dystrophy corneal endothelium as compare to the non-Fuchs dystrophy controls.71 Okumura et al also reported elevated PERK activation and CHOP expression in cultivated human Fuchs endothelial cells as compared to its normal controls.72 Both studies have shown that accumulation of unfolded proteins may induce corneal endothelial cell apoptosis.
Incidence of Fungal Infection in Positive Donor Rim Cultures after Corneal Transplantation
Published in Ocular Immunology and Inflammation, 2022
Julia Shatten, Roheena Kamyar, Deepinder Dhaliwal, Regis P. Kowalski, Vishal Jhanji
Demographics, indications for surgery, and clinical outcomes are summarized in Table 1. Recipient ages for those receiving transplants with a culture-positive donor rim ranged from 51 to 86 (median age was 69), nine recipients were male, seven were female. The most common indication for surgery was Fuchs’ Dystrophy followed by bullous keratopathy. Two patients had Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), four had Descemet Stripping Endothelial Keratoplasty (DSEK), two had Descemet Membrane Endothelial Keratoplasty (DMEK), two had a Penetrating Keratoplasty (PKP), one had a Boston Keratoprosthesis (KPro), and one had a corneoscleral graft (Table 1).
In-vivo Three-dimensional Characteristics of Bowman’s Layer and Endothelium/Descemet’s Complex Using Corneal Microlayer Tomography in Healthy Subjects
Published in Current Eye Research, 2020
Taher K. Eleiwa, Amr Elsawy, Zeba A. Syed, Vatookarn Roongpoovapatr, Ahmed M. Sayed, Sonia H. Yoo, Mohamed Abou Shousha
The advancement in anterior segment optical coherence tomography (AS-OCT) has allowed for in-vivo quantitative and qualitative evaluation of the cornea.1 The axial resolution has improved from 15–20 µm of time domain (TD-OCT) to 4–7 µm of the spectral domain (SD-OCT) or Fourier-domain OCT (FD-OCT), and 1–4 µm of High-Definition OCT (HD-OCT).2,3 Many studies have shown the potential utility of HD-OCT in the clinical diagnosis and management of a wide variety of corneal diseases.4–11 Two-dimensional (2D) mapping of Bowman’s layer (BL) using HD-OCT was reported to characterize BL thickness in healthy subjects,8,12 keratoconus (KC),13 and subclinical keratoconus.14 Abou Shousha et al. reported that the maximum Bowman’s layer ectasia index (BEI-MAX) had a very high accuracy to discriminate KC from normal corneas.13 Regarding subclinical KC, Zhe et al. reported that both maximum epithelium ectasia index (EEI-MAX) and BEI-MAX yielded the highest accuracy for discrimination of subclinical KC from normal corneas.14 Also, 2D mapping of endothelium/Descemet’s membrane (En/DM) complex was reported in Fuchs endothelial dystrophy,11 and corneal allograft rejection.15 In Fuchs’ dystrophy, a highly significant thickening of En/DM compared with normal subjects was reported.11 Likewise, relative thickening of the En/DM yielded the highest accuracy for diagnosis of graft rejection as measured by central En/DM thickness (DMT) and En/DM rejection index (DRI).15 All of these studies used diagnostic indices to specifically quantify the irregular alterations of the 2D thickness of BL and En/DM complex.