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Biomedical subjects

R Doyle Stulting

Publications and source records attributed to R Doyle Stulting.

At least 19 recordsLinked to original sources
PubMed2006

Ocular argyrosis after long-term self-application of eyelash tint.

PURPOSE: To report cases of ocular argyrosis that developed after long-term self-application of commercially available eyelash tint. DESIGN: Observational case series. METHODS: Case review, clinicopathologic analysis, and literature review. RESULTS: Three patients developed ocular argyrosis after the long-term self-application of Revlon Professional Roux Lash and Brow Tint (Colomer USA Corp, New York, New York, USA). Clinical evaluation revealed various degrees of silver deposition on the upper eyelid, lid margin, caruncle and conjunctiva, and diffuse Descemet's membrane deposits. In one case, histologic examination demonstrated silver deposition in the basement membrane and superficial substantia propria of the conjunctiva. CONCLUSIONS: Argyrosis can occur after long-term application of readily available eyelash tints, and the deposition of silver may be permanent. In certain circumstances, conjunctival argyrosis may simulate benign and malignant lesions, including conjunctival melanoma. These products should only be applied by trained cosmetologists.

Aged↗
PubMed2006

Corneal ectasia after photorefractive keratectomy.

Two patients developed corneal ectasia after photorefractive keratectomy (PRK). Case 1 had evidence of early keratoconus preoperatively, with manifest refractions of -4.00 +2.50 x 160 (20/20) in the right eye and -7.00 +3.00 x 180 (20/30) in the left eye; thin corneas (472 microm and 441 microm, respectively); and inferior paracentral steepening in the right eye and central steepening in the left eye on topography. Case 2 had manifest refractions of -8.50 +3.75 x 123 (20/20(-2)) in the right eye and -9.25 +4.00 x 077 (20/20(-1)) in the left eye; corneal thickness of 509 microm and 508 microm, respectively; and symmetric bow-tie patterns in both eyes on topography. Case 2 had a family history suspicious for keratoconus, with a sibling who had bilateral corneal transplantation at a young age. Both patients developed bilateral corneal ectasia after PRK.

Adult↗
PubMed2006

Prevention and treatment of corneal graft rejection: current practice patterns (2004).

PURPOSE: This study was designed to analyze current practice patterns in the prevention and treatment of corneal graft rejection and to compare these patterns with previously reported practices. METHODS: In January 2004, a survey addressing the routine postoperative management of corneal transplants and the treatment of various manifestations of corneal graft rejection was sent to members of The Cornea Society. RESULTS: Of the 396 surveys, 111 (28%) were returned and analyzed. All respondents used topical corticosteroids for routine postoperative management and treatment of endothelial graft rejection. Prednisolone, in brand or generic form, was used by 37 to 90% for routine management in various clinical scenarios and 81 to 91% for various manifestations of graft rejection at all time points; however, after 6 months, 12 to 26% used loteprednol etabonate for routine management. For routine management of high-risk grafts, 48% used topical cyclosporine in addition to prednisolone. Compared with previous surveys, the use of oral steroids significantly decreased for the routine management of high-risk corneal transplants, and the use of subconjunctival steroids decreased for the management of graft rejection. CONCLUSIONS: Topical prednisolone remains the mainstay for the prevention and treatment of corneal graft rejection; however, the role of newer agents, loteprednol etabonate and topical cyclosporine, is expanding.

Androstadienes↗
PubMed2006

Exacerbation of Avellino corneal dystrophy after LASIK in North America.

PURPOSE: To report the first case of Avellino corneal dystrophy exacerbation after LASIK in a white or North American patient. METHODS: Case report and literature review. RESULTS: A 25-year-old white female developed progressive corneal opacities after LASIK. Preoperative examination had revealed only subtle white corneal opacities in each eye. The patient's mother had similar corneal opacities. DNA analysis of the patient revealed a heterozygous mutation at the R124H location in the BIGH3 gene. CONCLUSIONS: LASIK can exacerbate Avellino corneal dystrophy and should be avoided in patients with this condition. A careful history and genetic analysis can identify affected patients and those at risk.

Adult↗
PubMed2006

Corneal ectasia after laser in situ keratomileusis in patients without apparent preoperative risk factors.

PURPOSE: To evaluate patients who developed ectasia with no apparent preoperative risk factors. METHODS: Potential cases of patients who developed ectasia without apparent risk factors were identified by contacting participants in the Kera-Net (n = 580), ASCRS-Net (n = 450), and ISRS/AAO ISRS-Net (n = 525) internet bulletin boards from April to October 2003. Cases were included if ectasia developed after laser in situ keratomileusis in the absence of apparent preoperative risk factors. Reported cases were excluded for the following reasons: (1) calculated residual stromal bed less than 250 microm, (2) preoperative central pachymetry less than 500 microm, (3) any keratometry reading greater than 47.2 diopters (D), (4) a calculated inferior-superior value greater than 1.4, (5) more than 2 retreatments, (6) attempted initial correction greater than -12.00 D, (7) an Orbscan II "posterior float" (if obtained) greater than 50 microm, and (8) surgical/flap complications. RESULTS: A total of 27 eyes of 25 patients were submitted for consideration. Eight eyes (8 patients) met our inclusion criteria. Mean age was 27.7 years (range, 18-41 years). Preoperative manifest refraction spherical equivalent was -4.61 D (range, -2.00 to -8.00 D); steepest keratometric reading was 43.86 D (range, 42.50-46.40 D); keratometric astigmatism was 0.93 D (range, 0.25-1.90 D); and preoperative central pachymetry was 537 microm (range, 505-560 microm). The mean calculated ablation depth was 82.8 microm (range, 21-125.4 microm), and mean calculated residual stromal bed was 299.5 microm (range, 254-373 microm). Mean time to recognition of ectasia onset was 14.2 months (range, 3-27 months) postoperatively. At the time of ectasia diagnosis, the mean manifest refraction spherical equivalent was -1.23 D (range, +0.125 to -3.00) with a mean of 2.72 D (range, 0.75-4.00 D) of astigmatism. CONCLUSIONS: Ectasia can occur after an otherwise uncomplicated laser in situ keratomileusis procedure, even in the absence of apparent preoperative risk factors.

Adolescent↗
PubMed2005

Negative dysphotopsia associated with implantation of the Z9000 intraocular lens.

Uneventful small-incision cataract surgery was performed in a 70-year-old man and a 62-year-old woman with implantation of a Tecnis Z9000 intraocular lens (IOL) (Pharmacia). No ocular pathology was present in the patients preoperatively. Unsolicited complaints of negative dysphotopsia were made postoperatively, and the symptoms have persisted for more than 1 year in both patients. Symptomatic negative dysphotopsia may be seen in association with the Z9000 IOL.

Aged↗
PubMed2005

A comparison of 2 methods for estimating residual stromal bed thickness before repeat LASIK.

PURPOSE: To compare 2 methods of calculating residual stromal bed (RSB) thickness after repeat LASIK, to determine which method generates more conservative RSB thickness estimates, and to determine any factors related to the discrepancy between these 2 calculation methods. DESIGN: Retrospective nonrandomized comparative trial. PARTICIPANTS: Seventy-nine patients (one eye per patient) undergoing primary LASIK and 2 repeat procedures (second and third LASIK) from 1998 to 2002. METHODS: We compared calculated RSB thickness after second and third LASIK using either original corneal thickness (CT) minus flap thickness and all ablations (original CT method) or pre-enhancement CT minus flap thickness and enhancement ablation (repeat CT method). MAIN OUTCOMES MEASURES: Differences in calculated RSB thickness after second and third LASIK by each method. RESULTS: Calculated RSB thickness averaged 329 microm by the repeat CT method compared with 305 microm by the original CT method after second LASIK (mean difference, 24 microm; P<0.0001) and 320 microm by the repeat CT method compared with 289 microm by the original CT method after third LASIK (mean difference, 31 microm; P<0.0001). After second LASIK, for 54% of eyes the repeat CT method was greater by >or=20 microm, and for 19% of eyes it was greater by >or=40 microm. After third LASIK, for 67% of eyes the repeat CT method was greater by >or=20 microm, and for 26% of eyes it was greater by >or=40 microm. The repeat CT method gave greater RSB thickness values than the original CT method in 73 of 79 eyes (92%) after second LASIK and in 72 of 79 eyes (91%) after third LASIK. The difference between the 2 methods was not associated with age, gender, initial preoperative refractive error, or refractive error before repeat LASIK. CONCLUSION: Using original preoperative CT measurements provides a more conservative and thus safer approach than using CT measurements obtained before repeat LASIK to calculate RSB thickness after repeat LASIK.

Adult↗
PubMed2005

Change in intraocular pressure measurements after LASIK the effect of the refractive correction and the lamellar flap.

OBJECTIVE: To study the relationship between intraocular pressure (IOP) readings after LASIK and the amount of refractive correction. DESIGN: Retrospective noninterventional case series. PARTICIPANTS: Patients receiving primary LASIK for myopia and myopic astigmatism. METHODS: A database of preoperative, intraoperative, and 3-month postoperative data for 8113 consecutive eyes that underwent primary myopic and myopic astigmatic LASIK was retrospectively reviewed. Linear regression analysis of measured IOP change as a function of refractive change was then performed. Age and preoperative keratometry were also reviewed by multiple regression. MAIN OUTCOME MEASURES: Best-fit curve relating change in measured IOP to refractive change. RESULTS: The mean spherical equivalent of the refractive change was -4.98+/-2.64 diopters (mean +/- standard deviation). The mean decrease in measured IOP was 2.0+/-3.3 mmHg. Linear regression analysis revealed a decrease of 0.12 mmHg of measured IOP per diopter of refractive change (95% confidence interval [CI], 0.09-0.15, R(2) = 0.009, P<0.001). Extrapolation of the data to a theoretical correction of zero diopters revealed a decrease of 1.36 mmHg (95% CI, 1.20-1.51, P<0.001), suggesting a component of measured IOP change that is independent of laser ablation. CONCLUSIONS: The reduction of IOP readings after corneal refractive surgery is a linear function of the amount of refractive correction, with an additional constant reduction that is probably related to the lamellar corneal flap. These data suggest that the lamellar corneal flap makes no contribution to the load-bearing characteristics of the post-LASIK cornea.

Adult↗
PubMed2005

No pathogenic mutations identified in the COL8A2 gene or four positional candidate genes in patients with posterior polymorphous corneal dystrophy.

PURPOSE: To identify the genetic basis of posterior polymorphous corneal dystrophy (PPCD) through screening of four positional candidate genes and the COL8A2 gene, in which a presumed pathogenic mutation has previously been identified in affected patients. METHODS: DNA extraction, PCR amplification, and direct sequencing of the COL8A2, BFSP1, CST3, MMP9, and SLPI genes were performed in 14 unrelated, affected patients and in unaffected family members. RESULTS: In the COL8A2 gene, the previously identified, presumed pathogenic mutation (Gln455Lys) was not discovered in any of the affected patients. A missense mutation, Thr502Met, was identified in 2 of the 14 affected probands, although it was not considered to be pathogenic, as it has been identified in unaffected individuals. Although several novel and previously identified single nucleotide polymorphisms producing synonymous and missense amino acid substitutions were identified in the COL8A2, BFSP1, CST3, MMP9, and SLPI genes, no presumed pathogenic sequence variants were found. CONCLUSIONS: No pathogenic mutations were identified in the COL8A2 gene or in several positional candidate genes in a series of patients with PPCD, indicating that other genetic factors are involved in the development of this autosomal dominant corneal dystrophy.

Collagen Type VIII↗
PubMed2004

Refractive changes after posterior segment surgery.

Retinal surgery can induce significant refractive errors. These errors include spherical changes caused by alterations in axial length after scleral buckle placement, astigmatic changes induced by a scleral buckle or pars plana vitrectomy, and focal alterations in corneal curvature that can significantly limit postoperative visual acuity. The adjunctive use of silicone oil can impose alterations directly, by the oil's interaction with the other refractive elements of the eye, and indirectly, through its effects on intraocular lens power calculations for subsequent cataract surgery.

Corneal Topography↗
PubMed2004

Surgical management of glaucoma in infants and children with Peters' anomaly: long-term structural and functional outcome.

OBJECTIVE: To determine the long-term outcome of surgery for congenital glaucoma in infants and children with Peters' anomaly. DESIGN: Retrospective review of a consecutive interventional case series. SETTING: An urban academic tertiary referral institution. PARTICIPANTS: Thirty-four eyes of 19 children are subjects of this report. Included are all children 12 years of age or younger with Peters' anomaly who underwent surgery for primary congenital glaucoma between January 1971 and December 1992 and completed a minimum of 3 years of follow-up from the date of the first glaucoma surgery. INTERVENTION: The surgical procedures performed were trabeculectomy, trabeculotomy, goniotomy, Molteno shunt implantation, cyclodialysis, and cyclocryotherapy. MAIN OUTCOME MEASURES: Primary outcome measures were intraocular pressure (IOP) control and final postoperative visual acuity. Intraocular pressure control was defined as complete success (IOP</=21 mmHg without antiglaucoma medication), qualified success (IOP</=21 mmHg with antiglaucoma mediation), or failure (IOP>21 mmHg with or without antiglaucoma medication, inoperable retinal detachment, phthisis, or chronic hypotony, defined as an IOP of </=6 mmHg). RESULTS: A total of 126 glaucoma procedures were performed on 34 eyes of 19 patients. The median age at time of first glaucoma surgery was 2.1 months (range, 2 days to 8.5 years). The median follow-up was 11.0 years (range, 3.2 to 22.8 years) from the time of first glaucoma surgery. Intraocular pressure control with or without antiglaucoma medication was achieved in 11 eyes (32%) after 1 or more surgical procedures. Major postoperative complications included graft failure in 26 eyes (76%), cataract in 6 eyes (18%), inoperable retinal detachment with phthisis in 12 eyes (35%), and phthisis alone in 6 eyes (18%). Final vision was 20/200 or better in 3 eyes (9%), 20/400 to hand motion in 12 eyes (35%), light perception in 7 eyes (21%), and no light perception in 12 eyes (35%). CONCLUSIONS: Glaucoma surgery, combined with medical therapy, may result in adequate, long-term IOP control in 32% of eyes with glaucoma associated with Peters' anomaly. Visual results are poor due to uncontrolled glaucoma, amblyopia, neurologic impairment, and other anterior and posterior segment anomalies that may accompany Peters' anomaly. Postoperative complications, including graft failure, cataract, inoperable retinal detachment, and phthisis, also contribute to decreased visual acuity.

Child↗
PubMed2004

Avellino corneal dystrophy after LASIK.

OBJECTIVE: To report cases of Avellino corneal dystrophy (ACD) exacerbated by LASIK for myopia. DESIGN: Retrospective, noncomparative, interventional case series and review of the literature. PARTICIPANTS: Seven patients. INTERVENTION: Six patients with exacerbation of granular corneal deposits after LASIK were examined for TGFBI mutations by polymerase chain reaction sequencing of DNA. One previously reported patient who was heterozygous for the ACD gene was followed up for 16 months after mechanical removal of granular deposits from the interface after LASIK. MAIN OUTCOME MEASURES: Slit-lamp examination, visual acuity, manifest refraction, and DNA sequencing analysis. RESULTS: All patients were heterozygous for the Avellino dystrophy gene. Corneal opacities appeared 12 months or more after LASIK. Best spectacle-corrected visual acuity decreased as the number and density of the opacities increased. One patient underwent mechanical removal of granules from the interface and had a severe recurrence within 16 months. Another patient had removal of the granules from the interface with PTK, followed by treatment with topical mitomycin C. In this patient, the cornea has remained relatively clear for 6 months. CONCLUSIONS: Laser in situ keratomileusis increases the deposition of visually significant corneal opacities and is contraindicated in patients with ACD. Mechanical removal of the material from the interface does not prevent further visually significant deposits. Mitomycin C treatment, in conjunction with surgical removal of opacities, may be an effective treatment.

Adult↗
PubMed2004

Using InterWave aberrometry to measure and improve the quality of vision in LASIK surgery.

OBJECTIVE: To compare visual outcomes in eyes undergoing aberrometry-guided (InterWave) LASIK with those in eyes undergoing standard LASIK treatment based upon refractive measures. DESIGN: Single-center, comparative, interventional, consecutive case series. PARTICIPANTS: Four hundred two consecutive eyes undergoing LASIK were analyzed retrospectively. One group, 106 eyes undergoing primary LASIK and 224 eyes undergoing LASIK enhancement, was treated with standard LASIK treatment using a 5.5-mm optical zone, 1.5-mm transition zone laser with the settings determined by manifest refraction. The second group, 44 untreated (primary) eyes and 28 previously treated (enhancement) eyes, received a multipass, multistage treatment in which the laser settings for each stage were determined by aberrometry measurements. Eyes with desired monovision (undercorrected) outcome and preoperative hyperopia were excluded from the study. INTERVENTION: An aberrometry-guided laser treatment (InterWave LASIK) was compared with the standard LASIK treatment based upon the manifest refraction. MAIN OUTCOME MEASURES: Uncorrected visual acuity (VA), manifest refraction, best spectacle-corrected VA (BSCVA), severity of halos, and root mean square (RMS) retinal blur area measured at 3 months postoperatively. RESULTS: Three months postoperatively there was no difference in uncorrected VA, BSCVA, refraction, or RMS retinal blur areas for pupil sizes of 3.5 mm between eyes treated by InterWave and those treated by standard LASIK. However, InterWave LASIK reduced the retinal blur area by 48% (P<0.0103) and 58% (P<0.0004) in primary cases and 43% (P<0.0430) and 74% (P<0.0271) in enhancement cases, respectively, for pupil sizes of 4.5 and 6.5 mm relative to standard LASIK treatments. Patients undergoing InterWave-guided treatment reported less severity of halo (0.37 vs. 0.98 [P<0.016] for primary cases and 0.35 vs. 0.73 [P<0.04] for enhancement cases). CONCLUSION: InterWave LASIK achieved acuity and refractive results equivalent to those of standard LASIK treatment based upon refraction, but resulted in superior quality mesopic vision.

Adult↗
PubMed2004

Corneal thickness changes during herpes simplex virus disciform keratitis.

OBJECTIVE: To describe the changes in corneal thickness determined by ultrasonic pachymetry during follow-up of herpes simplex virus disciform corneal edema. METHODS: Thirty-five patients with herpetic keratitis underwent slit-lamp biomicroscopy and ultrasonic pachymetry. Measurements during follow-up and at clinical resolution of corneal inflammation were compared with the initial corneal thickness. RESULTS: Corneal thickness of disciform stromal keratitis decreased 15% (95% confidence interval 10% to 20%) during follow-up, and 65% (95% confidence interval 43% to 88%) of this decrease occurred during the first 2 weeks. Increased central corneal thickness measured by pachymetry was associated with biomicroscopic detection of corneal edema (P = 0.03). CONCLUSIONS: Corneal pachymetry supplements clinical assessment of herpetic disciform edema.

Body Weights and Measures↗