Search PubMedSearch

Biomedical subjects

W J Stark

Publications and source records attributed to W J Stark.

At least 19 recordsLinked to original sources

Cytokine-induced calgranulin C expression in keratocytes.

The authors have identified a corneal stromal protein (CO-Ag) that may be involved in the pathogenesis of Mooren's ulcer. The CO-Ag cDNA sequence is identical to that of human neutrophil calgranulin C (CaGC). This study sought to demonstrate expression of the CaGC gene in the human cornea and in corneal keratocytes after cytokine stimulation. In situ hybridization and immunohistochemistry were used to localize CaGC mRNA and protein in normal and diseased human corneas, including a specimen with Mooren's ulcer. Cultured bovine keratocytes were stimulated with IL-1 alpha or TNF-alpha, and reverse transcription polymerase chain reaction (RT-PCR) was performed to amplify CaGC cDNA from cytokine-stimulated keratocytes and unstimulated controls. Southern blotting verified the specificity of the RT-PCR amplification products. In situ hybridization detected human CaGC mRNA in the stroma of corneas with Fuchs' dystrophy, postinfection corneas, and a cornea with Mooren's ulcer. In cultured bovine keratocytes, peak levels of CaGC mRNA were reached 6 h after cytokine stimulation. Southern blots with an oligonucleotide probe specific for CaGC detected the RT-PCR products of expected sizes (273 bp) and confirmed that the amplified CO-Ag sequence was identical to that of CaGC. These studies are the first to demonstrate the presence of CaGC in the human cornea and the ability of stromal keratocytes to produce CaGC (CO-Ag). The up-regulation of CaGC gene expression by corneal keratocytes due to proinflammatory cytokines from trauma or inflammation may induce autoimmunity that ultimately results in Mooren's ulceration.

Animals

Inflammatory response in the early stages of wound healing after excimer laser keratectomy.

OBJECTIVE: To evaluate the inflammatory response and its potential role in the early stages of corneal wound healing after excimer laser keratectomy. MATERIALS AND METHODS: Lewis rats underwent excimer keratectomy using a 193-nm excimer laser. The central corneas were ablated in 3 depths: group A, epithelium; group B, superficial stroma; or group C, deep stroma. Eyes were harvested 1, 12, 24, and 36 hours, and 1 week after the rats were killed. Immunohistochemistry was used to test frozen sections with monoclonal antibodies of various inflammatory cellular markers. RESULTS: Reepithelialization was observed at 12 hours in group A, and at 24 hours in groups B and C. Regenerated epithelium covered the denuded corneal surface in groups B and C after 1 week. The expression of major histocompatibility complex II antigen was detected in infiltrating cells, corneal epithelial cells, and endothelial cells 1 hour after surgery. Only a few macrophages and Langerhans cells were in the limbus at baseline. Macrophages migrated from the limbus to the corneal ablation zone and increased 2-fold after 36 hours in all 3 groups compared with baseline. Occasional lymphocytic infiltration was identified after 25 to 36 hours. CONCLUSION: Macrophages play an active role in the wound healing after laser keratectomy and may contribute to transient corneal haze.

Animals

Refractive and keratometric results after the triple procedure: experience with early and late suture removal.

OBJECTIVE: The objective of this study was to determine the outcome of early and late suture removal after the triple procedure (i.e., penetrating keratoplasty, cataract extraction, lens implant). DESIGN AND PARTICIPANTS: The refractive and keratometric results of 106 eyes undergoing the triple procedure were reviewed. The target postoperative refractive error was -1 diopter (D). RESULTS: Average length of follow-up was 40.3 months. Twenty eyes had sutures removed early (<18 months after surgery), 39 had sutures removed late (> or = 18 months after surgery), and 47 had sutures still intact at last follow-up. A best spectacle-corrected visual acuity of 20/40 or better was achieved in 90% of eyes with sutures removed early, 82.1% with sutures removed late, and 70.2% with sutures in place. For all eyes, the mean spherical equivalent at last follow-up was -2.50 D, with 75% of eyes falling between -4 and +2 D. The mean final refractive error was -3.40 +/- 3.53 D for eyes with sutures removed early and -1.79 +/- 3.99 D for eyes with sutures removed late. Eyes with sutures remaining had a mean final refractive error of -0.33 +/- 2.25 D. There was an overall decrease in refractive and keratometric astigmatism after both early and late suture removal with no significant difference between groups. However, there was a wide range of change with some eyes experiencing a decrease and others an increase in astigmatism. Mean postoperative K readings increased significantly for both groups after suture removal (final mean K, 47.00 D) but remained stable for eyes with sutures in. CONCLUSION: The authors data suggest that the final refractive error and net change in refractive and keratometric astigmatism after the triple procedure are not dependent on the timing of suture removal.

Aged

Defensin gene expression in the cornea.

PURPOSE: To determine whether defensin genes are expressed in human corneas and bovine corneal keratocytes. METHODS: In situ hybridization and immunohistochemistry were used to localize defensin mRNA and protein in normal and diseased human corneas. Cultured bovine keratocytes were stimulated with IL-1alpha or TNFalpha to determine whether defensin mRNA production occurred. Reverse transcription polymerase chain reaction (RT-PCR) was performed to amplify defensin cDNA from cytokine-induced keratocytes, and Southern blots were used to verify the specificity of RT-PCR amplification products. RESULTS: Defensin mRNA and protein were not detected in normal human corneal stroma, but were readily detectable in the corneal stroma in cases of rejected transplants and postinfectious keratitis. IL-1alpha was a potent inducer of defensin gene expression in keratocytes, which began 12 h after challenge and peaked at 18 to 24 h. TNFalpha weakly induced defensin mRNA in keratocytes at about 18 h. Southern blots of the RT-PCR products probed with an oligonucleotide complementary to internal sequences of defensin demonstrated the appropriately sized products (198 bp) specific for defensin. CONCLUSIONS: This report demonstrates the presence of defensin in the human cornea and the capacity of corneal keratocytes to produce defensin mRNA in response to IL-1alpha and TNFalpha. Release of defensins by keratocytes in response to cytokines elaborated in corneal inflammation may contribute to the host defense response in microbial keratitis.

Animals

Cataracts. Lifting the clouds on an age-old problem.

Cataracts are the most common treatable form of reduced vision in older adults. Although the incidence of cataracts is high after age 65, careful history taking and clinical examination are essential to establish the diagnosis. Cataract surgery is medically indicated when the view to the retina is obscured or lens-induced disorders place the eye at risk for further damage. However, even when patients have no specific associated medical problem, other than decreased visual acuity, cataract extraction offers an important means for maintaining independence and improving quality of life.

Activities of Daily Living

Prospective, randomized vector analysis of astigmatism after three-, one-, and no-suture phacoemulsification.

PURPOSE: To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification. SETTING: Johns Hopkins Hospital, Baltimore, Maryland and Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA. METHODS: This prospective, randomized study followed 131 patients treated with phacoemulsification with a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon sutures were used in the three- and one-suture groups. RESULTS: Mean astigmatism was greatest in the first postoperative week in all groups and stabilized after 8 weeks. The percentage of patients with with-the-rule (WTR) astigmatism increased from baseline in the one- and three-suture groups and decreased in the sutureless group. Mean uncorrected Snellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant differences in uncorrected acuity at other times. No statistically significant differences in the surgically induced spherical equivalent were noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively. At all follow-ups, the sutureless group had the greatest proportion of patients, with significant ATR astigmatic shift (1 week, 17%; 4 weeks, 32%); and the lowest proportion of patients with significant WTR astigmatic shift (10% after 1 week). At 4 weeks, the percentage of patients with significant WTR shift in the one-suture group dropped to that in the sutureless group (10%); however, those in the one-suture group had less ATR astigmatic shift (16%). CONCLUSION: Sutureless and one-suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-suture surgery resulted in less ATR shift.

Adult

Cloning and sequence analysis of human and bovine corneal antigen (CO-Ag) cDNA: identification of host-parasite protein calgranulin C.

PURPOSE: The primary structure of a cornea-associated antigen (CO-Ag) has been identified and has been implicated in the pathogenesis of Mooren's ulcer. The study designs were to isolate full-length clones encoding CO-Ag from a bovine and a human corneal cDNA library so that complete sequence analyses might further define the possible role of this protein in Mooren's ulcer. METHODS: DNA fragments of bovine and human CO-Ag were generated using unique oligonucleotide primers and reverse transcription polymerase chain reaction. These fragments were used as probes to obtain cDNA clones from a bovine and a human corneal cDNA libraries. The clones with the longest cDNA inserts were selected for sequence analyses. Human cDNA fragment was digested with Stu I and Hind III and cloned into a expression vector, pPROEXHT, at the same restriction enzyme sites. The plasmid was transformed into E. coli cells. Correct cloning and the full-length sequence of human CO-Ag were determined by sequencing the insert cDNA. RESULTS: The bovine cDNA insert sequence was 273 nucleotides in length for the entire mRNA coding region, 212 nucleotides in the 5' untranslated region, 83 nucleotides in the 3' untranslated region and a poly(A) tail. The DNA base sequence of this clone also contained a standard initiation codon, termination codon, and the polyadenylation signal. This cDNA predicts a protein which contains 91 amino acids with a molecular weight of 10,584 daltons. Plasmid expression vector, pPROEXHT-CO-Ag, was constructed that direct the synthesis of human CO-Ag in E. coli as fusion protein. Human CO-Ag fusion protein was purified to 90% pure with a yield of 17.2 mg per liter of the bacterial cell lysate. The nucleotide sequence of the CO-Ag cDNA insert was completely identical to human neutrophil calgranulin C. The deduced amino acid sequence was completely identical to a Ca(2+)-binding protein isolated on the surface of filarial nematodes. CONCLUSIONS: The isolation and analysis of cDNA clones containing the complete coding sequence of bovine and human CO-Ag proteins is reported. The proteins identified by deduced amino acid sequences demonstrate 100% sequence homology with human and bovine calgranulin C. Immune recognition of calgranulin C to a filarial nematode may lead to a hyperactive autoimmune response to CO-Ag in the cornea leading to a Mooren's ulcer.

Amino Acid Sequence

The association of postoperative subjective visual function with acuity, glare, and contrast sensitivity in patients with early cataract.

BACKGROUND: It has been shown in our previous studies that early cataracts affect vision in ways that can be measured by objective means and that this objective impairment in visual acuity, glare, and contrast sensitivity can be successfully reversed by cataract surgery. OBJECTIVE: To evaluate the association of subjective visual function with objective measures of acuity, glare, and contrast sensitivity in patients who were symptomatic from early cataract. METHODS: We administered a task-oriented questionnaire prior to and 4 months after cataract surgery to patients who were symptomatic from early cataract (median preoperative ETDRS [Early Treatment Diabetic Retinopathy Study] visual acuity of 20/40 [range, 20/20 to 20/80]); ETDRS visual acuity, disability glare, and contrast sensitivity were also measured at those times. RESULTS: Uncomplicated cataract surgery resulted in resolution or improvement of subjective symptoms for the great majority of subjects, and in a few subjects new symptoms developed or current symptoms worsened. We found a positive association between postoperative improvement in subjective visual function (as measured by the questionnaire) and postoperative improvement in objective visual function (as measured by visual acuity and contrast sensitivity). We also found that the greater the degree of preoperative impairment in objective visual function (as measured by visual acuity and contrast sensitivity), the greater the postoperative improvement in subjective visual function (as measured by the questionnaire). No such association was found for our disability glare test. CONCLUSIONS: Cataract surgery for symptomatic individuals with mild impairment in visual acuity does relieve visual symptoms, and preoperative measurement of contrast sensitivity can help determine who with early cataract is most likely to report subjective improvement in vision.

Adult

Objective measurement of corneal light scattering after excimer laser keratectomy.

PURPOSE: To obtain objective measurements of corneal light scattering after excimer laser keratectomy, and to evaluate the relation of light scattering to clinical haze grading and visual acuity. METHODS: The authors measured best-corrected visual acuity, subjective clinical haze grade, and corneal light-scattering index in patients undergoing photorefractive keratectomy (PRK) (n=26), and phototherapeutic keratectomy (n=8), preoperatively and postoperatively at 1,3,6,9, and 12 months or later. Corneal light scattering was correlated with visual acuity and clinical haze grade. RESULTS: Corneal light scattering increased after PRK and was reduced after phototherapeutic keratectomy. Corneal light scattering index showed a stronger positive correlation with logMAR visual acuity (r=0.57) than clinical haze grading (r=0.34). Corneal light-scattering index (P<0.05 at 1 and 3 months) and clinical haze grading (P<0.05 at 6, 9, and 12 months) were significantly higher in eyes undergoing PRK with ablation depths of more than 80 microns. CONCLUSIONS: Excimer laser surgery affects corneal light scattering. Ablations with depths greater than 80 microns produce significantly higher levels of haze than those less than 80 microns. Objective measurement of corneal light scattering may be useful in monitoring the outcome of excimer keratectomy.

Cornea

Phacoemulsification after retinal detachment surgery.

PURPOSE: Previous studies have documented a 3% to 15.5% risk of retinal redetachment in eyes with prior scleral buckling procedures that later undergo intracapsular or extracapsular cataract extraction. The authors reviewed the records of patients with a history of retinal detachment (RD) surgery and subsequent phacoemulsification to assess the risk of retinal redetachment and the visual outcomes. METHODS: Forty-seven eyes of 44 patients with a history of scleral buckling surgery who subsequently underwent phacoemulsification were identified. Features found before, during, and after surgery were reviewed. RESULTS: No retinal redetachments occurred on a mean follow-up of 2.3 years. Eyes with RD repair were more myopic than fellow eyes (P=<0.001), had longer axial lengths (P=0.001), had steeper keratometry readings (P=0.03), and had larger differences in K readings between principal meridians (P=0.01). Postoperative visual acuity was 20/40 or better in 72.3% of eyes and 20/80 or worse in 6.4% of eyes. Preexisting macular pathology was responsible for poor outcomes. CONCLUSION: The risk of redetachment after phacoemulsification in eyes with previous RD surgery is low. Despite retinal and cataract surgery, these eyes can achieve useful vision.

Adolescent

Intrastromal epithelial accretion follows deep excimer annular keratectomy.

The purpose of this study was to evaluate corneal reepithelialization and wound healing following annular excimer keratectomy. Two sets of experiments were performed on 35 rabbit eyes. In the first set of experiments, experiment I, deep Fresnel excimer keratectomy was performed, with a 6-mm outer and 3-mm inner diameter. Animals were sacrificed at 1, 5, 12, and 16 weeks, and corneas were examined by light and electron microscopy. In experiment II, the central epithelium was left intact, and superficial and deep mid-peripheral excimer annular keratectomies were performed measuring 6 mm in outer and 3 mm in inner diameter. Animals were sacrificed at 1 week, and corneas were examined by light microscopy. Following deep Fresnel excimer keratectomy (experiment I), corneas showed stromal edema in the central 3-mm zone. Intrastromal islands of epithelial cells with PAS positive basement membrane-like structures were seen histologically at 1 week. Electron microscopy showed loss of stromal collagen in areas adjacent to epithelial islands; in areas distant from the epithelial islands, the stromal collagen appeared normal. The overlying central stroma sloughed after 5 weeks. Anterior stromal scarring was observed. In experiment II (mid-peripheral annular keratectomy), intrastromal epithelial accretion was present in corneas with deep annular keratectomy but not in superficial annular keratectomy. Intrastromal epithelial accretion follows deep excimer annular keratectomy and is associated with adjacent stromal degradation.

Animals

The Castroviejo square graft.

The histopathologic features of three keratoplasty specimens from three cases involving square graft procedures performed by Dr. Castroviejo are reported. Light and electron microscopy were performed. In two of the cases, repeat keratoplasties were performed because of recurrent corneal dystrophies. In the third case, a repeat keratoplasty was performed because of graft failure.

Aged

The association of lymphocytotoxic antibodies with corneal allograft rejection in high risk patients. The Collaborative Corneal Transplantation Studies Research Group.

The Collaborative Corneal Transplantation Studies are a pair of multicenter prospective clinical trials evaluating the effectiveness of histocompatibility matching in high risk keratoplasty patients. The antigen matching study (AMS) evaluated HLA matching in patients without circulating lymphocytotoxic antibody to HLA antigens and the cross-match study (CS) evaluated the effect of using cross-match-negative donors in patients with identified circulating lymphocytotoxic antibodies to HLA antigens. Sera from 510 patients considered for enrollment in the studies were screened preoperatively for the presence of anti-class I lymphocytotoxic antibodies (LA). The 42 patients (8%) found to have detectable LA entered the CS. The 468 patients found not to have detectable LA preoperatively entered the AMS. Fifteen of the 37 transplanted CS patients were found to have donor-specific anti-class I antibody (before or after surgery). These patients were also screened for anti-class II LA and 25 had anti-class II panel reactive antibody > or = 5%. Forty-nine of the 419 transplanted AMS patients (12%) were found to have produced anti-class I LA after surgery, and in 19 patients, antibody specificities were those of donor HLA antigens. There was a significant association between the number of mismatched class I antigens and the number of donor-specific LA produced. The production of LA by AMS patients was significantly associated with reaction episodes; eighty-two percent of patients (40 of 49) with LA had reaction, compared with 63% of patients (230 of 365) without LA (P = 0.02). Likewise, production of donor-specific LA was significantly associated with immune-mediated graft failure (P = 0.025). For CS patients, there was no correlation between the production of donor-specific anti-class I or nonspecific anti-class II antibodies and graft outcome. However, the CS patients had poorer graft survival than did AMS patients at 3 years (57% vs. 66%, P = 0.01). These data demonstrate that LA, especially directed against donor class I HLA antigens following corneal transplantation in high risk patients, are associated with immune graft rejection and can be an indicator of allograft rejection.

Antilymphocyte Serum

Corneal complications of intraocular surgery.

Advances in intraocular surgery have decreased the incidence of corneal complications that result in corneal failure requiring transplantation. Interest continues in further refining surgery to minimize endothelial cell damage. New irrigating solutions, viscoelastic substances, and even new techniques have been introduced. Debate continues over certain issues, such as intraocular lens choice in the absence of capsular support. Improved design has prompted many early critics to regain confidence in the anterior chamber lens. Literature of recent years also reflects a shift in focus toward hastening recovery time and maximizing uncorrected visual acuity through the advantageous control of corneal astigmatism. Several reports this year may herald the next wave of interest, that surrounding intraocular surgery after refractive corneal surgery.

Cataract Extraction