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Background: Diagnostic tests for dry eye disease (DED), including ocular surface disease index (OSDI), tear breakup time (TBUT), corneal fluorescein staining, and lissamine staining, have great deal of variability. We investigated whether fluorophotometry correlated with previously established DED diagnostic tests and whether it could serve as a novel objective metric to evaluate DED., Methods: Dry eye patients who have had established signs or symptoms for at least 6 months were included in this observational study. Normal subjects with no symptoms of dry eyes served as controls. Each eye had a baseline fluorescein scan prior to any fluorescein dye. Fluorescein dye was then placed into both eyes, rinsed with saline solution, and scanned at 5, 10, 15, and 30 min. Patients were administered the following diagnostic tests to correlate with fluorophotometry: OSDI, TBUT, fluorescein, and lissamine. Standard protocols were used. P < 0.05 was considered significant., Results: Fifty eyes from 25 patients (DED = 22 eyes, 11 patients; Normal = 28 eyes, 14 patients) were included. Baseline scans of the dry eye and control groups did not show any statistical difference (p = 0.84). Fluorescein concentration of DED and normal patients showed statistical significance at all time intervals (p < 10(-5), 0.001, 0.002, 0.049 for 5, 10, 15, & 30 min respectively). Fluorophotometry values converged towards baseline as time elapsed, but both groups were still statistically different at 30 min (p < 0.01). We used four fluorophotometry scoring methods and correlated them with OSDI, TBUT, fluorescein, and lissamine along with adjusted and aggregate scores. The four scoring schemes did not show any significant correlations with the other tests, except for correlations seen with lissamine and 10 (p = 0.045, 0.034) and 15 min (p = 0.013, 0.012), and with aggregate scores and 15 min (p = 0.042, 0.017)., Conclusions: Fluorophotometry generally did not correlate with any other DED tests, even though it showed capability of differentiating between DED and normal eyes up to 30 min after fluorescein dye instillation. There may be an aspect of DED that is missed in the current regimen of DED tests and only captured with fluorophotometry. Adding fluorophotometry may be useful in screening, diagnosing, and monitoring patients with DED.

Purpose: To evaluate and compare the wavefront characteristics of normal eyes with and without hydrogel soft contact lenses for correction of myopia., Methods: Higher order aberrations (HOA) of 30 eyes of 15 soft contact lens users who had no ocular diseases other than myopia were quantified with a Nidek Marco three dimensional Wave wavefront analyzer. Zernike's polynomial was used to describe the wavefront measurements. Root mean square (RMS) values of the total HOAs, total coma, total trefoil and total spherical aberrations were obtained in the same eyes with and without soft contact lenses. We used paired sample t-test to analyze the data., Results: Mean RMS values for all higher order aberration components with and without soft contact lenses were: total HOA 0.364 +/- 0.129 microm without lenses and 0.456 +/- 0.175 microm with lenses (P = 0.01), total coma 0.203 +/- 0.095 microm without lenses and 0.220 +/- 0.133 microm with lenses (P = 0.51), total trefoil 0.193 +/- 0.074 microm without lenses and 0.254 +/- 0.153 microm with lenses (P = 0.06), total spherical aberration 0.126 +/- 0.121 microm without lenses and 0.148 +/- 0.095 microm with lenses (P = 0.36)., Conclusions: Wavefront analysis showed soft contact lenses for myopia induced a significant increase in total HOA. Though total coma, trefoil and spherical aberrations were also higher with contact lenses they were not statistically significant when individually evaluated and compared to values without contact lenses.

Purpose: To evaluate visual outcome and corneal shape change during the first month of wearing corneal refractive therapy (CRT) reshaping contact lenses to correct myopia in otherwise healthy eyes., Methods: Twenty-nine eyes were fit with Paragon CRT contact lenses, which were worn nightly. Before and after CRT fitting, uncorrected visual acuity was measured, and corneal topography was performed and evaluated with the Holladay Diagnostic Summary EyeSys 2000 Videokeratoscope. To evaluate the visual outcome, refractive yield (achieved/attempted correction) was calculated and accounted for distance or monovision., Results: Uncorrected visual acuity improved in all patients. In 1 month, refractive yield was 96.7%. Corneal uniformity index and predicted corneal acuity index were maintained, and the Q value changed from -0.08 to +0.38 (P < 0.05)., Conclusions: CRT lenses are effective in improving visual acuity. They significantly changed the corneal from prolate to oblate while maintaining corneal quality.

Purpose: To present a case of Maroteaux-Lamy syndrome (MLS, mucopolysaccharidosis [MPS] type VI) who underwent bone marrow transplantation (BMT) for gene transfer at the age of 13, and penetrating keratoplasty at the age of 17, and maintained clear corneal grafts bilaterally for 13 years. To our knowledge, this is the longest follow-up reported on corneal graft survival in a patient with MLS and BMT., Methods: In 1982, BMT was successfully performed on a 13-year-old girl with MLS with growth retardation, typical facial features, skeletal and joint deformities, hepatosplenomegaly, cardiopulmonary dysfunction, and corneal clouding. Corneal transplantation was done on the left eye in 1986, and on the right eye in 1987 (6 months later) without difficulty or complication., Results: Thirteen years postoperatively, the patient was systemically well, and both eyes retained clear corneal grafts., Conclusion: BMT retarded further dysfunction from MLS, and the corneal transplants retained clarity. Further controlled studies with longer follow-up are required to establish the efficacy of BMT in ocular manifestations of MPS or MLS.

Purpose: To evaluate the long-term visual results in patients having Intacs placement for the correction of mild myopia., Setting: Department of Ophthalmology, Mount Sinai School of Medicine and the Mount Sinai Hospital of Mount Sinai NYU Health, New York, New York, USA., Methods: Patients with mild myopia (spherical equivalent between -0.75 and -4.50 diopters [D]) were enrolled to have Intacs placement between May 1995 and March 1999 under United States Food and Drug Administration Phase II and Phase III clinical trials for intrastromal corneal ring segments (ICRS). Six insert thicknesses were evaluated: 0.21, 0.25, 0.30, 0.35, 0.40, and 0.45 mm. The long-term results evaluated were uncorrected visual acuity (UCVA), maintenance of best spectacle-corrected visual acuity (BSCVA), predictability and stability of the refractive effect, induced manifest refraction cylinder, slitlamp findings, self-reported visual symptoms, and maintenance of mesopic contrast sensitivity., Results: One hundred fourteen eyes of 73 patients were enrolled; 113 eyes of 72 patients received Intacs. There were no serious intraoperative or postoperative complications. The mean follow-up was 17.5 months +/- 8.9 (SD). At the end of this period (number of eyes evaluated = 100), the UCVA was 20/40 or better in 95 eyes (95.0%), 20/20 or better in 72 (72%), and 20/16 or better in 41 (41%). None of the 113 eyes lost 10 or more letters or 2 or more lines of preoperative BSCVA. The mean change in the cycloplegic refraction spherical equivalent for the 6 insert thicknesses was as follows: -0.75 +/- 0.00 D for 0.21 mm; -1.17 +/- 0.42 D for 0.25 mm; -2.00 +/- 0.54 D for 0.30 mm; -2.59 +/- 0.53 D for 0.35 mm; -3.09 +/- 0.54 D for 0.40 mm; and -3.82+/-0.80 D for 0.45 mm. The refractive correction was within +/-1.0 D of the predicted outcome in 103 eyes (92.0%) and within +/-0.5 D in 72 eyes (63.7%). Intacs were removed from 6 eyes (5.3%). All 4 eyes for which data were available 3 months after removal returned to within +/-0.5 D of their preoperative manifest refraction spherical equivalent. Intacs were exchanged because of undercorrection in 2 eyes (1.8%). These eyes gained 3 and 5 lines of UCVA 12 months and 18 months, respectively, after the exchange procedure. Overall, 85.7% (36/42) of the patients were satisfied with the results of the Intacs procedure., Conclusion: Intacs safely and effectively corrected mild myopia. Placement is a brief, easy outpatient procedure. The refractive effect was predictable and stable over long-term follow-up. Results from a limited number of removal and exchange procedures indicate that Intacs are removable and adjustable.

Purpose: Reactivation of latent herpes simplex virus (HSV) by excimer laser photorefractive keratectomy(PRK) has been reported previously in the literature. This study evaluates the extent of such HSV reactivation and determines whether corneal de-epithelialization prior to PRK or the laser treatment itself induces this response., Methods: Twenty three normal 1.5-2.5 kg New Zealand white rabbits were infected on the surface of the cornea with HSV-1, strain RE. The animals were monitored until resolution and then divided into two treatment groups: 1) de-epithelialization alone, and 2) de-epithelialization plus laser. Animals were evaluated in a masked fashion by clinical examination and viral cultures twice a week through day 28., Results: The reactivation rate for group 1 (de-epithelization alone) was 0.0%, and for group 2 (PRK) was 67% by slit lamp biomicroscopy. Viral culture positivity rate matched these findings., Conclusions: Excimer laser (193 nm) treatment can trigger viral shedding and reactivation of herpetic ocular disease in the latently infected rabbit. De-epithelialization alone is not sufficient to cause such viral reactivation or keratitis. Our findings suggest that patients with a history of herpetic keratitis undergoing PRK are at increased risk of HSV reactivation as a result of exposure to the excimer laser.

Purpose: To compare the keratometric readings obtained from Intraoperative PAR Corneal Topography System (IOPAR) to those produced by manual keratometer (Mnl-Km), autokeratometer (Auto-Km), EyeSys CAS (EyeSys Corneal Analysis System) and slit lamp PAR CTS in healthy eyes., Methods: All instruments were calibrated prior to use and only data from the best image obtained was used for statistical analysis. Simulated keratometry readings obtained from the central 3-mm zone of the corneas by IOPAR, including flat (K1) and steep (K2) keratometry readings, average keratometric power (AK), astigmatism (As) (difference between steep and flat keratometry readings) and the axis of the steep meridian (Ax) were compared to those from four other units. The latter units were also compared among themselves. Statistical analysis was done for right and left eyes separately. For each variable, average differences between the measurements taken from pairs of instruments were estimated, with corresponding 95% confidence intervals. The degree of agreement between pairs of instruments on individual measurements was additionally assessed, via the use of "Bland-Altman"-type plots, and estimates of the proportion of cases achieving satisfactory agreement. Additionally, for every variable, the average of the measurements taken from the different instruments were compared., Results: Forty-five (22 right and 23 left) normal corneas of 26 volunteers were examined. On the average, IOPAR tended to measure K1 higher than slit lamp PAR CTS system. Because K2 measurements taken by the IOPAR were higher than that of all other instruments, the As measurements, on the average, were also higher than that of others, with the exception of the PAR CTS. For the same reasons, the IOPAR produced average AK readings that were higher than those taken by EyeSys CAS and PAR CTS. When the individual measurements taken by the IOPAR were compared with each of the other units, according to the arbitrary designation of satisfactory agreement within +/-0.5 D (for K1, K2, AK, and As) and +/-20 degrees (for Ax), for almost all parameters, proportion of differences that were within the agreement range varied from 0.33 to 0.82, with wide confidence intervals (confidence interval lower limits ranging from 0.20 to 0.61 and upper limits ranging from 0.62 to 0.94)., Conclusions: IOPAR is a clinically useful topographic system, producing qualitative and quantitative data in the operating environment that, in normal corneas, on the average, matches those produced by the other units in the clinic. When individually analyzed, its keratometric measurements may show greater variations with respect to other units. Further studies with multiple examiners, in corneas with high or irregular astigmatism are required to establish its reproducibility and efficacy.

Purpose: To evaluate the usefulness of measuring corneal topography intraoperatively by Intraoperative PAR Corneal Topography System (IOPAR CTS) to predict the postoperative topographical changes in patients undergoing refractive surgery., Methods: Topographical measurements of 9 eyes of 9 patients were taken by IOPAR CTS: 6 immediately after Intrastromal Corneal Ring Segments (ICRS) placement surgery and 3 immediately after Photorefractive Keratectomy (PRK) surgery. The topographical images taken by IOPAR CTS were analyzed to determine the quality of the image produced and the correlation of the keratometric data from the central 3 mm of cornea with measurements taken from an autokeratometer (Auto-Km) and the EyeSys Corneal Analysis System (CAS) for the same eyes taken three months following the procedure., Results: At the 3-month postoperative exam, the correlation coefficients for flat (K1), steep (K2), and average keratometry (AK) readings produced by the Auto-Km and the EyeSys CAS were quite high. However, the correlation coefficients for K1, K2, AK, As or steep meridian axis (Ax) readings taken intraoperatively by IOPAR CTS were quite low when compared to the readings taken by either the Auto-Km or EyeSys CAS three months postoperatively., Conclusion: We found IOPAR CTS, relatively difficult to perform in the operating room during refractive surgical procedures and not useful clinically in predicting the postoperative topographical changes induced by ICRS or PRK procedure. Further studies are required to establish the efficacy and reproducibility of the instrument.

Purpose: To describe a case of photorefractive keratectomy after removal of intrastromal corneal ring segments from the cornea., Methods: During United States Food and Drug Administration Phase III Trials for intrastromal corneal ring segments (ICRS), the implanted segments were removed from the cornea of the right eye of a patient because of dissatisfaction with glare, halos, and fluctuating vision. Ten months after ICRS explantation, the-patient underwent a photorefractive keratectomy procedure to the same eye., Results: One month after removal of the ICRS, the patient's manifest refraction was within +/- 0.50 diopters of his original manifest refraction. Photorefractive keratectomy was planned to the same eye 6 months later. At the first attempt, the epithelium could not be removed with the laser and scrape technique, and residual epithelium was noted at the vertical meridian (12 o'clock) corneal incision site, which had been used for ICRS surgery and explant; therefore, the procedure was aborted. At the second attempt, with a mechanical epithelial brush (AMOILS Epithelial Scrubber; Innova, Inc, Toronto, Canada), the epithelium was removed with ease. After this, photorefractive keratectomy was done without difficulty or complication. At his most recent 8-month postphotorefractive keratectomy examination, the patient had an uncorrected visual acuity of RE: 20/16, with a manifest refraction of -0.75 to 0.75 x 170 degrees, a faint haze at the site of the stromal channel, and a small scar at the incision site on slit-lamp examination., Conclusions: Intrastromal corneal ring segments can be readily removed from the cornea, if required. In this case, the refraction returned to its preoperative state soon after the explant procedure and remained stable over time. Photorefractive keratectomy was performed as a secondary refractive surgical procedure after the removal of ICRS without difficulty or complication. However, removal of the epithelium is probably best accomplished with the use of an epithelial brush, considering the changes in the epithelial adherence in a postsurgical cornea. Further studies are required to establish the safety and efficacy of secondary refractive surgical procedures after ICRS explantation.

Purpose: A new class of antiviral agent, cobalt chelates (the CTC series), was evaluated for treating epithelial herpetic keratitis, consequent stromal disease being the major infectious cause of blindness in industrial nations., Methods: Effects of CTC complexes were monitored in cell cultures and in a rabbit eye model, either infected with herpes simplex virus type 1 (HSV-1) or uninfected. Several antiviral concentrations of CTC complexes nontoxic to Vero cells were administered to rabbit eyes with HSV-1-induced keratitis. Corneal surface virus titers were measured, and corneal lesions of epithelial keratitis were monitored by slit-lamp microscopy and scored. Recovery rates and incidence were compared in eyes treated with CTC complexes, placebo, or clinically formulated trifluorothymidine (Viroptic), using nonparametric statistics., Results: All CTC complexes inhibited HSV-1 replication in vitro, CTC-96 being best. CTC-96, CTC-23, and CTC-67 eliminated (<1 plaque-forming unit[pfu]) corneal surface HSV-1 (otherwise >10(5) pfu) in order of descending potency, but CTC-82 was ineffective. CTC-96 (either 5 microg/ml six times daily or 10 microg/ml five times daily) accelerated herpetic dendritic keratitis recovery better than or the same as trifluorothymidine (10 mg/ml nine times daily). CTC complexes were nontoxic to Vero cells continuously exposed to < or =25 microg/ml; 50 microg/ml of CTC 96 nine times daily did not irritate uninfected rabbit eyes., Conclusion: Topical CTC-96 applications were at least as effective as Viroptic in diminishing disease signs and corneal surface virus at concentrations less than one-thousandth that of Viroptic.

We used high-frequency ultrasound B-scanning with digital signal processing for pachymetric analysis of corneal scars to help determine the optimal management strategy. Four patients were selected for this report. By an automated motor system, 12 consecutive, parallel ultrasound B-scans, each 2.5 to 3 mm wide at 0.25 mm intervals, were obtained from the central corneal area of three patients with anterior corneal scarring. In a fourth patient with near complete corneal scarring obscuring the view of the anterior chamber, a set of 15 mm wide B-scans was obtained. Digitized ultrasound signals were used to produce high-resolution images and I-scans enabling a pachymetric precision of +/- 2 microns (SD). Epithelial, scar, and corneal thickness measurements were made along each scan to determine the most significant zone of pathology. Pachymetry of the cornea and the individual layers was used to assess the suitability for either photorefractive or penetrating keratectomy. B-scan imaging of the full anterior segment provided useful information for the preoperative planning of anterior segment reconstruction and the prognostic evaluation of penetrating keratoplasty. This method provides a powerful tool for the corneal surgeon in management planning.

We conducted a retrospective assessment of the fitting characteristics obtained with the Boston Envision rigid gas permeable contact lens to determine the best parameter for selecting an initial base curve. We fit 13 subjects (11 successfully) with the Envision lens, using computerized videokeratoscopy to evaluate prefitting corneal topography. The selected base curve of the lenses fit most closely to the flattest K at the 5 mm zone. This value may be the best parameter for selection of an initial base curve, especially in eyes with keratoconus. Using topographic information may give quicker and more accurate initial fits than keratometry alone.

The first operated eyes of 435 patients undergoing radial keratotomy in the Prospective Evaluation of Radial Keratotomy (PERK) study were evaluated by photokeratography to document the preoperative and postoperative corneal shape. We determined by regression analysis and analysis of variance that the corneal shape preoperatively improved the prediction of the corneal shape 6 months postoperatively in the 3-mm-clear-zone population. The reduction of myopia in all 435 eyes ranged from 1.25 to 9.75 diopters. We studied the effect of the preoperative corneal shape on this variability in the outcome of the surgery using rings 2 and 7 on photokeratography and corneal diameter. In the 3-mm-clear-zone group, eyes with flat prolate corneas had a greater reduction in myopia (4.65 D); those with steeper, more spherical corneas had less reduction in myopia (3.48 D). In addition, eyes with a 3-mm clear zone and flat central corneas alone (8.0 mm = 42.19 D) flattened approximately 0.75 D more than those with steep central corneas (7.0 mm = 48.21 D). In the 3.5-mm and 4.0-mm clear zone groups, the change in corneal curvature was not related to the preoperative curvature. A stepwise regression analysis of the 151 eyes in the 3.0-mm-clear-zone population demonstrated the following predictive equation for radial keratotomy; change in cycloplegic refraction = -14.55 + [-2.097 x average ring-2 radius] + [3.605 x average ring-7 radius] + [0.69 x horizontal corneal diameter] + [0.079 x age] + [-0.379 x spherical equivalent cycloplegic refraction]. There was a 1.17-D observed difference in the effect of radial keratotomy between those eyes with a steep/steep corneal topography (7.2% of the 3.0-mm-clear-zone population) and the flat/flat topography (29% of the 3.0-mm-clear-zone PERK population). A knowledge of corneal topography provides an additional tool for understanding the operative variability of radial keratotomy.

There are conflicting reports on the propensity of topical beta blockers to produce corneal anaesthesia. We measured corneal sensitivity thresholds quantitatively for 10 minutes following the administration of one drop of topical timolol maleate (0.5%), betaxolol hydrochloride (0.5%), or saline in 30 eyes of 18 normal subjects in a randomised, double-masked study. Most subjects had insignificant changes in corneal sensitivity thresholds. We identified, however, a subgroup of four subjects (five eyes) that had a marked and prolonged increase of corneal sensitivity threshold (corneal anaesthesia) after timolol (three eyes) and betaxolol (two eyes). The group mean age of these 'responders' (49.0 years) was significantly greater (p less than 0.005) than that of the non-responders (35.0). We recommend periodic measurements of corneal sensitivity in older patients receiving topical timolol or betaxolol, especially when given in higher concentrations, to identify responders, who may be at risk of developing keratitis.

Corneal curvature was evaluated in 70 children by central keratometric measurements. The mean keratometric reading in each age group was seen to decline systematically from birth to about 54 months of age. The mean in the newborn-to-6-month-old group was 47.59 D; in the 12-18-month-old group it had decreased to 45.56 D. The cornea appears to stabilize at about 54 months, with an average reading of 42.69 D. Evaluation of 11 eyes diagnosed as having persistent hyperplastic primary vitreous revealed that eyes with this diagnosis generally have steeper corneas than normal eyes at any given age.

A method to devitalize single layers of apically exposed rabbit corneal epithelial cells through the use of digitonin is described. Devitalized cells exfoliate spontaneously as loosely cohesive, trypan-blue-stained layers, exposing underlying viable cells. Repeated application of this devitalization-exfoliation methodology results in the gradual elimination of each of the epithelial cells. The generation of corneal surfaces composed of the tear-facing membranes of all intraepithelial cell types--subsurface, wing, and basal--is thus attainable. Exposed surfaces were studied with respect to microanatomy, the binding of lectins, and the adherence of Pseudomonas aeruginosa. Microprojections (microvilli or microplicae) were absent in the basal cells but were present in all suprabasal layers, and increased gradually in density as cells approached the surface position. Wheat germ agglutinin and concanavalin A were found to bind to the tear-facing membranes of all suprabasal cell layers. The tear-facing membrane of the basal cells, in contrast, was not labeled. Within each labeled layer, the magnitude of lectin binding differed markedly from cell to cell; lectin binding decreased as the cellular area exposed to the tear surface increased. Pseudomonas were found exclusively at microprojection-free cellular areas, suggesting that inhibition of attachment is linked to the ontogeny of these microprojections.

Anterior radial keratotomy was performed with a diamond blade in ten rhesus monkey eyes. Results were compared with those of a previous study in which a metal blade was used. Histologic assessment showed endothelial degeneration, but fewer edematous endothelial cells, than in the previous study. Specular microscopy demonstrated statistically significant endothelial cell losses (7.99%), when preoperative and three-month postoperative values were compared. Autoradiography showed little cell division in the endothelial cell layer. Cell loss seemed to be repaired mainly by the spreading of neighboring cells. Endothelial cell division is also limited in humans, and the cumulative loss of cells due to surgical trauma combined with continuous damage-related losses and later age-related reductions in cell numbers could produce corneal decompensation in some patients years after radial keratotomy.

We performed anterior radial keratotomy on the right eyes of nine rhesus monkeys, making eight incisions of various depths from 0.36 to 0.5 mm with a No. 76-A Beaver blade. After three months, corneal buttons were obtained from the operated on eyes of seven monkeys by penetrating keratoplasty and two monkeys were killed, and both operated and unoperated on eyes were enucleated. We examined the specimens by scanning and transmission electron microscopy. We saw linear protrusions on the posterior cornea beneath and parallel to the radial keratotomy incisions in all cases. There were swollen endothelial cells at the central cornea in three eyes. In eight corneas, we saw damaged endothelial cells with invading inflammatory cells. The control eyes showed no abnormal histologic findings. These findings suggested that deeper incisions cause more endothelial damage, possibly in relation to structural weakness produced in the cornea. We think that cuts in Bowman's membrane and in the stromal tissue may cause corneal stretching, resulting in a continuing process of injury to the endothelial cell layer. There may be long-term, continuing damage to the corneal endothelium after anterior radial keratotomy.

Anterior radial keratotomy was performed on nine Green monkey eyes. Four of these eyes received subconjunctival corticosteroid injections immediately after surgery and three times thereafter at three-week intervals. Two eyes received subconjunctival physiologic salt solution injections on the same schedule. Three eyes received no injections after surgery. Although endothelial cell loss in the first week after surgery was reduced in the drug-treated eyes, there were no statistically significant differences in cell densities at nine months after surgery. Corticosteroid therapy after anterior radial keratotomy appeared to confer no long-range benefits in terms of the numbers of corneal endothelial cells in these primate eyes.

Langerhans cells (LC) appear to have a role in the processing of antigens presented through cutaneous surfaces. In most species LC are found in the conjunctiva and limbal epithelium but are rarely found in the central cornea. A quantitative study of corneal LC was performed in guinea pigs and rabbits with HSV-1 keratitis. Corneal epithelial sheets were removed, stained with ATPase and counted in the peripheral, paracentral and central cornea. Results in guinea pigs showed statistically significant increases of LC on days 6, 16, 21 and 28 in the paracentral and central cornea of HSV eyes. Results in rabbits showed an increase in LC on days 9, 13 and 21 in the paracentral and central cornea of HSV eyes. No LC were found in the central cornea of control eyes. The results indicate a migration of LC to the central cornea as a result of HSV keratitis.

After radial keratotomy (RK) to correct myopia, some patients complain of 'glare'. Effects of a glare source on contrast sensitivity were measured in fifteen patients after unilateral RK. With each eye, determinations were made of the contrast required for detection of steady gratings (spatial frequencies of 0.7 and 2.9 cycles/deg), and for detection of flicker (unpatterned field flickering at rates of 8, 16, and 32 Hz). Grating or flicker was presented on a centrally fixated 4 deg test target (34 cd/m2 mean luminance), surrounded by a diffuse glare source (1700 cd/m2 mean luminance). For each stimulus, contrast thresholds were determined with glare-source off and with glare-source on. 'Glare loss' was defined as the decrement in contrast sensitivity measured with the glare source on. Significant findings were: (1) Both eyes showed glare losses for detection of gratings and for detection of flicker; (2) Spectacle lenses increased glare losses both for gratings and for flicker; (3) The RK eye showed a larger glare loss for flicker than the unoperated eye, but a smaller glare-loss for gratings; (4) For both flicker and gratings, glare loss tended to be greater in the RK eye, compared to the unoperated eye, in subjects who had larger pupil diameters in the testing situation; (5) The psychophysical measurements obtained in this study were not significantly correlated either with a questionnaire index of glare complaints or with the score obtained with the Miller-Nadler GlareTester.

We used specular microscopy to study the corneal endothelium of eight aphakic patients who had undergone epikeratophakia. The average post-operative period was 16 months with a range of 12 to 18 months. Corneal thickness increased from 0.52 mm +/- 0.01 mm to 0.88 mm +/- 0.04 mm with the addition of the onlay graft. The average pre-operative endothelial cell count was low (1,450 per mm2 +/- 218) and did not differ significantly (p greater than .9) from the average postoperative cell count (1,438 per mm2 +/- 218). Despite the increase in corneal thickness and low endothelial cell counts, we saw no corneal edema. We conclude that epikeratophakia is well tolerated by the cornea and can be performed safely on eyes that have already undergone substantial trauma to the endothelium.

Abstract Introduction SkQ1 (Visomitin) is a novel mitochondrial-targeted antioxidant that holds promise in the treatment of inflammation associated with ocular surface diseases such as dry eye disease (DED) and corneal wounds. However, the specific role of SkQ1 in ocular surface epithelial tissue has yet to be explicated. The goal of this study is to identify roles of SkQ1 in conjunctival inflammation and corneal wound healing. Methods To determine the role of SkQ1 in inflammation, human conjunctival epithelial (HCjE) cell cultures were sensitized with pro-inflammatory cytokine tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) followed by treatments with SkQ1. The production of inflammatory biomarker prostaglandin E2 (PGE2) and cell viability were quantitatively evaluated. To determine the role of SkQ1 in wound healing, human corneal limbus epithelial (HCLE) cell cultures were streaked to create wounds. The wound closure times, ability to support single HCLE cell proliferation and changes of cell migration in the presence of SB203580, an inhibitor of p38 mitogen-activated protein kinase (MAPK), were further compared. Results The HCjE and HCLE cultures showed no apparent cytotoxicity to SkQ1 in concentrations up to 250 nM (HCjE) or 2500 nM (HCLE). The HCLE cultures showed no toxicity to SkQ1 at all the SkQ1 concentrations tested. SkQ1 significantly suppressed PGE2 production of HCjE at concentrations < 300 nM (24 h) and 50 nM (48 h), apparently being SkQ1 dose and treatment time dependent. The wound closure rates were increased by 4% in 4 h and by 9% after 8–12 h in the presence of 50 nM SkQ1. Furthermore, as little as 25 nM of SkQ1 significantly stimulated HCLE single-cell proliferation. Lastly, the SkQ1-stimulated wound healing was completely abolished by SB203580. Conclusion Results of the current study demonstrate that SkQ1 exhibits an anti-inflammatory role and can be safely applied to ocular surface epithelium up to a concentration of 300 nM (181 ng/ml) for 24 h. SkQ1 also significantly enhances corneal epithelial wound healing, likely through enhancement of cell proliferation and migration. The data provide solid support for SkQ1 as a promising new therapeutic strategy for treatment of conjunctival inflammation as well as corneal wounds. Funding This study was sponsored by Mitotech SA Pharmaceuticals.