Search

Author(s): Iva Krolo [1,2,3]; Aida Kasumović Bećirević (corresponding author) [1,4]; Ivana Radman [1]; Armin Kasumović [1]; Ines Matoc [1]; Idoia Goñi Guarro [1]; Ivan Sabol [5] Fuchs' endothelial corneal dystrophy [...], Purpose: To investigate the functional and structural daily variations in eyes with a mild form of Fuchs&apos; endothelial corneal dystrophy (FECD). Methods: This prospective study included 30 eyes with the mild form of FECD. Subjects underwent functional and structural testing at 8 AM, 2 PM, and 8 PM. Testing included measurement of uncorrected distance visual acuity (UDVA), best corrected twilight vision (TV), and contrast sensitivity function (CSF) testing (Vista Vision Far-Pola, DMD MedTech charts). Corneal epithelial and stromal parameters were evaluated with anterior segment optical coherence tomography (AngioVue, AvantiRTVue-XR; Optovue, CA, USA). Results: UDVA, TV, and CSF for spatial frequencies B, C, and F showed significant changes during the day, with the lowest values in the morning (P < 0.0001 for UDVA, P = 0.0109 for TV, and P < 0.0001, P = 0.0126, and P = 0.0471 for the three spatial frequencies, respectively). There was no significant change in epithelial parameters between visits. Central corneal thickness showed significant decrease during the day (P < 0.0001), as did the central stromal thickness on the 5- and 7-mm maps (P = 0.0002 and P < 0.0001, respectively), stromal thickness in the superior section of the 5-mm map (P = 0.0107), stromal thickness in the inferior section of the 7-mm map (P = 0.0002), and minimal stromal thickness on both maps (P < 0.0001). Conclusion: A significant negative correlation was found between central stromal thickness and TV, implying that simultaneous evaluation of corneal layers and visual quality may be useful in assessing FECD. Keywords: Anterior segment optical coherence tomography, epithelial corneal maps, Fuchs&apos; corneal dystrophy, stromal corneal maps, visual quality

Objective: To investigate the potential role of apoptosis in the pathogenesis of Fuchs endothelial dystrophy of the cornea. Methods: Twenty-one corneal buttons from patients with Fuchs dystrophy and 15 control corneas were studied. Apoptosis was assessed by the in situ end-labeling of double-stranded DNA breaks, and by immunohistochemical characterization of cellular markers associated with apoptosis (Fas, FasL, Bcl-2, and Bax). Expression of Bcl-2 and Bax mRNA in the corneal stroma and endothelium was separately analyzed by a semiquantitative reverse transcriptase polymerase chain reaction. Furthermore, cultivated keratocytes generated from diseased corneal buttons and donor rims were exposed to camptothecin, an apoptotic inducer, for 6 and 24 hours. They were then examined for protein and messenger RNA (mRNA) expression of apoptotic regulatory molecules. Results: DNA fragmentation was seen in the epithelium, stroma, and endothelium in 6 of 7 corneas with Fuchs dystrophy. A statistically significant difference was identified in the expression of Bax and its mRNA in the stroma, but not in the endothelium of Fuchs dystrophy corneas. Following exposure to camptothecin, keratocytes from patients with Fuchs dystrophy responded with an increased level of Bax and a low level of Bcl-2. This trend was distinctively different from the response of normal keratocytes. Conclusions: The evidence in this study points to a disease-related disturbance in the regulation of apoptosis in Fuchs dystrophy. Our findings suggest that excessive apoptosis may be an important mechanism in the pathogenesis of Fuchs dystrophy. Arch Ophthalmol. 2001;119:1597-1604

The formation of protein crystals in the cornea, the covering over the front portion of the eyeball, is called crystalline keratopathy. This eye disorder may be a symptom of multiple myeloma, a cancer of the bone marrow, and other monoclonal gammopathies, diseases in which there is an increase in blood levels of immunoglobulins, which are specialized proteins involved in immune responses. The nature of paraproteins or abnormal proteins in crystalline keratopathy is not known. A case is described of a 59-year-old man with multiple myeloma who developed rapidly progressive crystalline keratopathy. The paraproteins detected in the blood, cornea, and aqueous humor, a fluid within the eye, were analyzed by various biochemical techniques. The results indicated the presence of an unusual immunoglobulin with an abnormal structure, including altered sulphur-containing bonds between the molecules of this protein. Alterations of protein structure may be responsible for crystallization of these paraproteins. Thus, the change in the chemical structure of this paraprotein may contribute to the disease process of crystalline keratopathy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background: The balance between matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs) determines the extent of connective tissue degradation and remodeling. Objective: To determine whether pterygium, characterized by fibrovascular invasion into the cornea, may in part be mediated by an increased activity of MMPs. Materials and Methods: Expression of transcripts and proteins of MMPs, TIMPs, and urokinase plasminogen activator (uPA) by cultured human pterygium head, body, and subconjunctival fibroblasts, and normal corneal and conjunctival fibroblasts were determined by Northern hybridization, enzyme-linked immunosorbent assay, Western blotting, zymography, and quantitative collagenase assay, respectively. Results: Compared with normal conjunctival fibroblasts from 6 subjects, the expression of MMP-1 and MMP-3 transcripts was dramatically increased in pterygium head fibroblasts of 8 patients, but not in pterygium body fibroblasts of 6 patients. The protein levels and collagenolytic and caseinolytic activities of MMP-1 and/or MMP-3 were also markedly increased in pterygium head fibroblasts. The MMP-1 and MMP-3 proteins and activity decreased in order from pterygium head to body to subconjunctival fibroblasts. There was no difference in the transcript and protein expression of MMP-2, TIMP-1, TIMP-2, and uPA among these groups. Conclusion: Pterygium head fibroblasts express increased mRNA, protein, and activities of MMP-1 and MMP-3. Clinical Relevance: Overexpression of MMP-1 and MMP-3, a phenotype previously linked with UV exposure in dermal fibroblasts to explain the pathologic finding of elastotic degeneration, suggests that pterygium head fibroblasts might be intrinsically altered by UV, which might be responsible for corneal invasion. Arch Ophthalmol. 2001;119:71-80

Signs and symptoms: The patient with band keratopathy can be of any age. There may be a history of chronic, recurrent anterior uveitis or other ocular inflammatory disease. There may [...]

Dr. Krenzer is an assistant professor at the New England College of Optometry. Understanding the process of infiltrate formation can help you select an appropriate response. When there is an [...]

Clear vision requires a transparent cornea and this depends on proper endothelial pumping to keep the cornea free of fluid. Failure of this pump to function properly, which may occur as a result of eye disease, will cause corneal edema. There have been recent reports of primary endotheliitis, or inflammation of the endothelial tissues. Previously described cases of idiopathic corneal endotheliitis have involved focal areas of corneal edema related to an immune response developed against a donated cornea, and diffuse corneal edema associated with an inherited condition. The authors present two cases of acute diffuse corneal endotheliitis for which there is no known cause. Neither patient had a family history of the eye disease. Specular photography demonstrated inflammatory material deposited on the edematous endothelium. The corneal edema responded to treatment with G. prednisolone (a corticosteroid) and showed only an insignificant loss of endothelial cells. A classification of idiopathic primary endotheliitis is presented. The two reported cases of endotheliitis appear to be the result of an autoimmune response or an unidentified viral infection; the disease process may be similar to that seen in the rejection of corneal transplants. (Consumer Summary produced by Reliance Medical Information, Inc.)