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Biomedical subjects

E E Manche

Publications and source records attributed to E E Manche.

27 records · Page 2Linked to original sources
PubMed1995

Rupture of radial and arcuate keratotomy scars by blunt trauma 91 months after incisional keratotomy.

PURPOSE/METHODS: We studied a case in which blunt trauma caused dehiscence of radial and arcuate corneal scars 91 months after incisional keratotomy. The ruptured incisions did not extend beyond the corneoscleral limbus. RESULTS/CONCLUSIONS: Incisional refractive surgery renders the cornea susceptible to blunt traumatic rupture. This vulnerability results from the intrinsic weakness of the keratotomy wounds. Our case documents that this weakness persists up to 91 months after the operation.

Adult↗
PubMed1991

Microfibril-microvessel connections in the rabbit eye: correlative confocal and electron microscopy.

The connections between elastic tissue and microvessels (arterioles, capillaries, and venules) in the rabbit eye were examined by light and electron microscopy. In particular, confocal scanning laser microscopy of tissue stained with orcein and examined by fluorescence using a rhodamine filter was correlated with electron microscopic observations. The goal was an analysis of the way in which elastic tissue of the uvea (i.e., choroid, ciliary body, and iris) and the optic nerve of the eye connect to the microvessels in these structures. Confocal microscopy revealed these connections advantageously and showed how they link the elastic tissue meshwork in the perivascular tissue spaces with the wall of the blood vessels. Electron microscopy showed that the connections consist of bundles of 10-12 nm diameter microfilaments that insert into vascular basement membranes. These connections may contribute to the vascular response to changes in blood pressure or intraocular pressure in the eye.

Animals↗
PubMed1990

Ultrastructural evidence of remodelling in the microvasculature of the normal rabbit and human eye.

Several investigators have recently presented ultrastructural evidence for remodelling in the mammalian, including human, choriocapillaris. This evidence consists of cytoplasmic processes off endothelium and pericytes that penetrate the basal lamina of the capillary and enter the pericapillary space and redundant layers of basal lamina interpreted as the result of secretory activity subsequent to cellular movement within the wall of the capillary. This report extends these observations to the remaining microvasculature of the choroid--its arterioles and venules--and to another part of the ocular microvasculature--the pars plana of the ciliary body--of the rabbit and human eye. Cytoplasmic processes and redundant basal laminae were observed in the microvasculature at both sites, most frequently associated with venules and capillaries. Cytoplasmic processes and redundant basal laminae are generally associated with cellular movement and vessel growth during ocular neovascularization. However, their presence in histologically normal eyes suggests that these phenomena occur in the absence of neovascularization, i.e. that the microvasculature is remodelled in the normal eye.

Animals↗
PubMedDate not supplied

Lamellar keratoplasty for hyperopia.

PURPOSE: Lamellar keratoplasty for hyperopia (automated lamellar keratoplasty for hyperopia) can correct hyperopia by weakening the cornea with a deep lamellar resection. The safety and efficacy of the procedure is uncertain. METHODS: Twenty-four eyes of 17 patients underwent hyperopic lamellar keratoplasty using the automated corneal shaper (Chiron Corp, Irvine, Calif) by one surgeon using a flap technique. The mean attempted correction was +3.90 +/- 0.90 D (range, +2.00 to +6.00). The eyes were followed for 1 month (23 eyes) to 6 months (17 eyes). RESULTS: Six months after hyperopic lamellar keratoplasty, the mean difference between attempted and achieved correction was an undercorrection of +1.40 +/- 0.80 diopters (D) with 7 of 17 eyes within 1.00 D of the attempted correction. No eyes were overcorrected, and 15 eyes were undercorrected. In eyes with a refractive goal of emmetropia, uncorrected visual acuity was 20/40 or better in 13 of 15 eyes and 20/20 or better in 8 of 15 eyes. No eye lost two or more lines of spectacle-corrected visual acuity at 3 or 6 months postoperatively. Between 1 and 6 months, there was a mean hyperopic shift of 0.20 D. There was clinically significant epithelial ingrowth into the interface in two eyes. CONCLUSION: Hyperopic lamellar keratoplasty is an effective method of reducing hyperopia and induces little irregular astigmatism. The nomogram we used produces a consistent undercorrection. Refraction appears to stabilize at 1 month, but longer follow up is necessary to assess stability.

Adult↗
PubMedDate not supplied

Sterile peripheral keratitis following laser in situ keratomileusis.

BACKGROUND: Sterile infiltrates have been reported as a possible complication following photorefractive keratectomy (PRK). They have not been reported following laser in situ keratomileusis (LASIK). We review a case of fleeting, sterile peripheral corneal infiltrates following LASIK. METHODS: A 53 year old patient developed peripheral, sterile corneal infiltrates along the edge of the primary flap following LASIK. This was successfully managed with topical antibiotics and corticosteroids without permanent sequelae. RESULTS: Sterile peripheral corneal infiltrates are now a known complication following LASIK. Pathogenesis is undetermined but may involve activation of marginal keratitis reminiscent of that following blepharitis or a mechanism similar to acute subepithelial infiltrative keratitis following PRK. CONCLUSION: Fleeting, sterile peripheral corneal infiltrates can occur following LASIK. This undesired complication is poorly characterized but can be successfully managed with culturing of the infiltrates, topical corticosteroids, and antibiotics.

Anti-Bacterial Agents↗
PubMedDate not supplied

Prospective study of photorefractive keratectomy for hyperopia using an axicon lens and erodible mask.

PURPOSE: To evaluate prospectively the long-term safety, efficacy, and visual performance following photorefractive keratectomy (PRK) for hyperopia using an erodible mask and axicon lens system. METHODS: Eighteen eyes of 9 patients with a mean preoperative spherical equivalent refraction of +2.26 +/- 0.82 D (range, +1.13 to +4.00 D) underwent PRK with the Summit Apex Plus excimer laser following manual scraping of the epithelium. Eyes were prospectively evaluated 1, 3, 6, 9, 12, 18, and 24 months following the procedure. Primary outcome variables included cycloplegic refraction and uncorrected visual acuity (UCVA). Visual performance was determined by contrast sensitivity measurements under scotopic (21 lux) and photopic (324 lux) conditions and best spectacle-corrected visual acuity (BSCVA) under scotopic, photopic, and glare conditions. RESULTS: For 18 eyes, 98.2% of the mean preoperative spherical equivalent refraction was corrected to +0.04 +/- 0.87 D (range, -1.38 to +2.00 D) at 24 months after PRK. Twelve eyes (67%) were within +/-0.50 D of attempted correction and 15 eyes (83%) were within +/-1.00 D. Stability within +/-0.50 D was achieved after 6 months. Two eyes (11%) experienced almost complete regression of the refractive effect. There was no statistically significant decrease in contrast sensitivity under scotopic or photopic conditions. (P > .05). Best spectacle-corrected visual acuity showed progressive improvement in the early postoperative period. By 24 months, 0 eyes (0%) lost 2 or more lines of BSCVA under scotopic and photopic conditions and 1 eye (5.5%) lost 2 or more lines under glare conditions. Fourteen eyes (78%) had grade 1 to 3 anterior stromal haze at 24 months which was characteristically mid-peripheral and did not adversely affect visual performance. CONCLUSION: Photorefractive keratectomy with the the Summit Apex Plus excimer laser for low to moderate hyperopia resulted in an effective reduction of hyperopia without compromising long-term visual performance. Stability and recovery of distance uncorrected and best spectacle-corrected visual acuity took approximately 6 months.

Contrast Sensitivity↗
PubMedDate not supplied

Late onset diffuse lamellar keratitis associated with an epithelial defect in six eyes.

PURPOSE: To report six cases of late onset diffuse lamellar keratitis associated with epithelial defects 2 to 12 months following uncomplicated laser in situ keratomileusis (LASIK). METHODS: Retrospective case series. RESULTS: The interface inflammation and epithelial defects were treated aggressively with topical corticosteroids and topical antibiotics with complete resolution over 1 to 2 weeks. There were no complications or loss of best spectacle-corrected visual acuity. These cases illustrate new understanding in the etiology of diffuse lamellar keratitis following lamellar surgery. CONCLUSION: Late onset diffuse lamellar keratitis in association with epithelial defects may occur following LASIK. Treatment with topical antibiotics and topical corticosteroids may result in uncomplicated, complete resolution.

Administration, Topical↗
PubMedDate not supplied

Treatment of progressive or recurrent epithelial ingrowth with ethanol following laser in situ keratomileusis.

PURPOSE: To evaluate the use of ethanol in the treatment of progressive or recurrent epithelial ingrowth following laser in situ keratomileusis (LASIK). METHODS: Four eyes of four patients with aggressive epithelial ingrowth following LASIK underwent epithelial ingrowth removal with 50% ethanol. Aggressive epithelial ingrowth was defined as, 1) progressive enlargement on serial examination with an area of ingrowth involving at least 30% of the flap surface area, 2) epithelial ingrowth associated with stromal melting as evidence on clinical or topographic examination, or 3) recurrent epithelial ingrowth in the same area following previous removal. RESULTS: Epithelial ingrowth was removed successfully in all eyes. No eye lost best spectacle-corrected visual acuity. One eye with multiple risk factors for failure experienced nonprogressive recurrence. No eyes required reoperation for recurrent epithelial ingrowth. No eyes experienced progression of stromal melt. Regularization of corneal topography was observed in an eye with preoperative stromal melting. The only complication was a tendency for the development of diffuse lamellar keratitis. Two eyes (50%) experienced diffuse lamellar keratitis following epithelial ingrowth removal with ethanol, which resolved completely with topical corticosteroids. CONCLUSION: Ethanol may be a useful adjunct in the treatment of aggressive or recurrent epithelial ingrowth following LASIK. Cautious use with the lowest concentration of ethanol may prove useful in these difficult epithelial ingrowth cases. Randomized and prospective studies are recommended to evaluate our experience.

Adult↗