Corneal epithelial adhesion studies.
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Adhesiveness↗
Biomedical subjects
W J Stark
Publications and source records attributed to W J Stark.
Prevalence of map-dot-fingerprint changes in the cornea.
Map-dot-fingerprint basement-membrane abnormalities of the cornea are common in the general population, affecting as many as 76% of persons over age 50 and 42% of persons of all ages. The prevalence of this condition in the general population is not significantly different from that found in families of patients with recurrent corneal erosions and map-dot-fingerprint corneal changes. Despite this extremely high prevalence of basement-membrane changes the incidence of recurrent erosive symptoms in total groups of patients with basement-membrane changes is quite rare, suggesting that these 2 entities are possibly not related. Although previous observers have suggested an autosomal dominant mode of inheritance of these basement-membrane changes, our data raise the possibility that map-dot-fingerprint basement-membrane changes represent an age-dependent, degenerative condition of the cornea. We were unable, however, to prove either hypothesis.
Adolescent↗
Management of epithelial ingrowth and cysts.
In 12 consecutive cases of epithelial ingrowth operated on during the past 50 months, therapy included photocoagulation on the iris followed by excision of involved iris tissue and vitreous gel by means of instruments designed for vitreous surgery. Epithelium remaining on the posterior surface of the cornea, the ciliary body, and in the anterior chamber was destroyed by controlled transcorneal and transscleral cryotherapy. An intraocular air bubble was used to provide an insulating effect and a more effective, controllable freeze. All patients except two had improved vision postoperatively, and 3 of the 12 patients has postoperative visual acuity of 6/12 (20/40) or better. Similar closed-eye cryodestructive techniques have been used for treatment of enlarging epithelial cysts.
Anterior Chamber↗
Vitrectomy techniques for managing selected intraocular lens complications.
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Cataract Extraction↗
Surgical management of persistent hyperplastic primary vitreous.
Instruments designed for pars plana vitrectomy can be used to manage complicated congenital cataracts such as those with persistent hyperplastic primary vitreous (PHPV). We have applied closed-eye vitrectomy techniques through a limbal approach in seven eyes with PHPV. A clear pupillary space was achieved in all cases. The management of children with complicated congenital cataracts such as PHPV is discussed.
Cataract↗
Transplantation antigens and keratoplasty.
Allograft rejection is one of the leading causes of corneal graft failure in man when the cornea is heavily vascularized. This paper reports the feasibility and possible benefits of using histocompatibility (HLA) antigen cross-match testing for corneal donor selection. Such cross-match testing does not require the matching of individual HLA antigens of donor and recipient. A double-masked clinical trial designed to determine the value of this procedure for keratoplasty is discussed.
Adolescent↗
Combined keratoplasty, cataract extraction, and intraocular lens implantation: experience at the Wilmer Institute.
A review of 12 cases of combined keratoplasty, cataract extraction and IOL implantation performed during the past five years at the Wilmer Institute is presented. The results show 80% of cases with 6/12 (20/40) vision or better with a follow-up of at least six months. All but one of the grafts remained clear. Our current technique for keratoplasty, extracapsular cataract extraction and posterior-chamber IOL implantation is described. This technique has several advantages, including the following: an intact posterior capsule, no anterior vitrectomy, protection of the cornea from the IOL by the iris, and potential for full pupil dilation after surgery. Conservative and highly selective use of the procedure is recommended.
Aged↗
Corneal wound healing: holographic stress-test analysis.
Double-exposure holograms are taken of the patient's cornea after a heartbeat. The resulting stress test, or holographic interferogram, shows sharply demarcated fringe patterns outlining structurally weak areas in the cornea. Wound strength in postoperative keratoplasties is now being evaluated on a routine basis to determine the effect of topical medications and surgical techniques. All grafts measured to date reveal "bulging" or weakness of the wound margin by holography even though clinically they are fully "healed." Only one patient had a vascularized region of the wound that was stronger than surrounding cornea. It is no longer necessary to resort to pulling the wound apart in animals for measurement of tensile strength.
Adult↗
Anterior segment surgery using instruments designed for pars plana vitrectomy.
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Humans↗
Management of epithelial cysts of the anterior chamber.
Epithelial cysts in the anterior chamber are treated only if they obstruct the pupil or cause other serious complications. A closed-eye method is used in aphakic eyes to collapse the cyst and devitalize the epithelial cells using cryotherapy without incising the cyst wall. In phakic eyes, the cyst is dissected away from the cornea and the partially excised through an open-sky approach followed by transscleral cryotherapy to devitalize epithelial remnants. Four of seven eyes operated on with these methods were successfully treated without complications. Persistent cystoid macular edema occurred in two of the other three eyes, and one eye developed a postoperative sheet-like epithelial ingrowth requiring further surgery and resulting in corneal edema. The cyst did not recur in any of these seven eyes.
Adult↗
Specular microscopy of iridocorneal endothelia syndrome.
Clinical specular microscopic examination of 17 patients with features common to the iridocorneal endothelial syndrome (including Chandler's syndrome, iris nevus syndrome, and essential iris atrophy) showed pathognomonic endothelial changes and no areas of normal endothelial mosaic. Even in those patients with minimal anterior synechiae, gross central endothelial changes could be found, suggesting that the endothelial changes are primary and not secondary to the iris-corneal adhesions. Specular microscopy of the clinically uninvolved contralateral eye in these patients revealed frequent endothelial cell pleomorphism incommensurate with the patient's age. This study also confirmed the value of the specular microscope for qualitative endothelial observations.
Adolescent↗
Hereditary Fuchs' Dystrophy.
We studied 102 individuals from 25 families in which at least one member was known to have Fuchs' endothelial dystrophy. We used slit-lamp examination, corneal pachymetry, and specular microscopy. We also examined pathology records which contained 79 cases of penetrating keratoplasties done solely for phakic Fuchs' dystrophy between 1940 and 1978. Although there was a marked predominance of females in our review of pathology records, our clinical study provided a more even sex distribution. There was a close correlation between the number of expected and observed affected first-degree relatives based on an autosomal-dominant mode of inheritance. We observed a fairly typical corneal pattern, beginning as a circumscribed area of central or paracentral cornea guttata, and thereafter expanding more horizontally than vertically with progression of severity. Fuchs' dystrophy appears to be a true corneal dystrophy with autosomal-dominant inheritance, a high degree of penetrance, and variable expressivity, with generally increased severity among females.
Adolescent↗
The keratopathy of Crohn's disease.
A distinctive subepithelial keratopathy developed in four adult patients with Crohn's disease (granulomatous ileocolitis). Small, bilateral, symmetrical subepithelial, and anterior proliferative infiltrates and scarring were present 2 to 3 mm inside the entire corneoscleral limbus. Vision was not affected because the lesions spared the central cornea. The mechanism is not known and the lesion should be regarded as a distinct clinical sign of Crohn's disease.
Adult↗
Management of retropseudophakos membranes.
Retropseudophakos membranes are becoming a more frequent problem. When simple discission is not successful in creating an adequate pupillary space, instruments and techniques designed for pars plana vitreous surgery provide advantages over conventional methods for dealing with selected reto-IOL membranes.
Cataract↗
Immunoprotein deposition in the cornea.
A 63-year old woman had bilateral, multi-level corneal deposits distributed as fine, discrete crystals and in dense, deep geographic patches. She had a long history of sero-positive rheumatoid arthritis. Autopsy revealed an unsuspected lymphoproliferative disorder and immune-complex disease. Histologic examination of the eyes revealed eosinophilic, PAS-positive, noncollagenous deposits in the cornea at all levels and also in the ciliary processes, pars plana, and choroid. Stains for gold, amyloid, and acid mucopolysaccharides were negative. Immunoperoxidase stains were positive for IgG most strongly, and also for IgA, kappa and lambda light chains. Transmission electron microscopy showed needle-like electron-dense extracellular particles which we presume are immunoglobulins.
Cornea↗
Postoperative inflammatory reactions to intraocular lense sterilized with ethylene-oxide.
Postoperative inflammatory complications after intraocular lens implantation have increased since we have been using lenses manufactured by American companies and sterilized with ethylene-oxide, as compared with lenses from European companies sterilized by sodium hydroxide. The possible sources of this complication are discussed.
Aged↗
Specular microscopy of irido-corneal endothelial syndrome.
Clinical specular microscopic examination of 17 patients with features common to the irido-corneal endothelial syndrome (including Chandler's syndrome, iris nevus syndrome, and essential iris atrophy) revealed pathognomonic endothelial changes and no areas of normal endothelial mosaic. Even in those patients with minimal anterior synechiae, gross central endothelial changes could be found, suggesting that the endothelial changes are primary and not secondary to the iris-corneal adhesions. Specular microscopy of the clinically-uninvolved contralateral eye in the patients revealed frequent endothelial-cell pleomorphism incommensurate with the patient's age. This study also confirmed the value of the specular microscopy in making qualitative endothelial observations.
Adult↗
Iris suture fixation for the four-loop Binkhorst intraocular lens.
A simple and easy technique for inserting an iris fixation suture for use with a four-loop Binkhorst lens is described. The preplaced 10-0 Prolene fixation suture permits pupillary dilatation after the insertion of a four-loop Binkhorst lens and prevents inadvertent dislocation of the lens.
Humans↗