The Experts below are selected from a list of 84 Experts worldwide ranked by ideXlab platform
Steven E Wilson - One of the best experts on this subject based on the ideXlab platform.
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dry eye associated with laser in situ keratomileusis mechanical microkeratome versus femtosecond laser
Journal of Cataract and Refractive Surgery, 2009Co-Authors: Marcella Q Salomao, Renato Ambrosio, Steven E WilsonAbstract:Laser in situ keratomileusis (LASIK) remains the most commonly performed refractive surgical procedure.1 Advances in techniques and instruments have reduced the incidence and severity of flap abnormalities and other potentially severe complications of LASIK. One of the most common problems after surgery is LASIK-associated dry eye.2–4 One condition that is thought to play an important role in dry eye after LASIK is LASIK-induced neurotrophic epitheliopathy (LINE), a term suggested by Wilson2 and Ambrosio et al.3 to describe the neurotrophic component of LASIK dry eye and that results from damage to the nerves during flap formation and stromal ablation.2–4 Corneal innervation is an integral component of the lacrimal gland–ocular surface functional unit,5 which coordinates basal and stimulated tear production, lid blinking, tear spreading, and tear clearance.2–9 In addition, neurotrophic factors released from corneal nerves are important in the normal physiology of corneal Epithelial cells.10 Denervation of the central cornea after LASIK is the result of surgical amputation of the nerve fibers produced by flap cutting and stromal ablation.2–4,6–9 The significant decrease in sensation in the area of the flap after LASIK normally recovers in a progressive manner from 3 to 9 months after LASIK.3,8,11–13 This nerve recovery is best seen on confocal microscopy3 and generally correlates with resolution of, or at least marked improvement in, LASIK-induced dry eye.3 Frequently, LINE is seen in LASIK patients who do not have underlying chronic dry-eye disease before surgery. In other LASIK patients,4 a combination of chronic dry eye, albeit mild, and superimposed neurotropic epitheliopathy contribute to the symptoms and signs of the postoperative disorder. In either case, the typical presentation involves corneal Punctate Epithelial Erosions that are best seen using lissamine green or rose bengal staining as well as well as symptoms such as fluctuating vision, blurred vision, stinging, pain, photophobia, and visual fatigue.2,3,11,14–16 Many patients with LINE have no symptoms or only mild fluctuations in vision.2,3 The lamellar cut to fashion the flap for LASIK can be performed using a mechanical microkeratome or a femtosecond laser. Our clinical experience with the IntraLase femtosecond laser (Abbott Medical Optics, Inc.) over the past few years has given us the clinical impression that the incidence and severity of LASIK-associated dry eye is less with that mode of flap creation than with the Hansatome microkeratome (Bausch & Lomb). Thus, we performed a retrospective study to compare the incidence of LASIK-associated dry eye and the need for postoperative cyclosporine A treatment between femtosecond laser flap creation and mechanical microkeratome flap creation.
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laser in situ keratomileusis induced presumed neurotrophic epitheliopathy
Ophthalmology, 2001Co-Authors: Steven E WilsonAbstract:Abstract Objective To evaluate tear production, corneal topography, accuracy of refractive correction, and best spectacle-corrected visual acuity in eyes that had moderate to severe rose bengal staining develop on the flap compared with eyes with little or no staining on the flap, the first few months after laser in situ keratomileusis (LASIK). None of the eyes in this study had significant preoperative dry eye disease. Design Retrospective case control study. Participants Individual eyes of 19 consecutive patients with moderate to severe Punctate Epithelial Erosions and rose bengal staining on the flap 1 to 3 months after LASIK were compared with eyes of 19 concurrent patients who did not have Punctate Epithelial Erosions or more than trace staining on the flap develop. Methods Nonparametric statistical analyses were used to compare tear secretion, corneal topographic irregularity, spherical equivalent, and visual acuity 3 and 6 months after surgery. Some eyes in both groups also had analysis of tear secretion 1 month after surgery. Main outcome measures Schirmer’s test without anesthesia, the topographic corneal irregularity measurement (CIM), the difference between attempted and achieved spherical equivalent, and the loss of best spectacle-corrected visual acuity. Results There was no difference in tear production 1, 3, or 6 months after LASIK in patients who had Punctate Epithelial Erosions and rose bengal staining on the flap develop and those who did not. There was no significant difference in the CIM or mean accuracy of the refractive correction in the two groups, but some patients had a transient decrease in best spectacle-corrected visual acuity. Flap rose bengal staining resolved by 6 months after LASIK in most affected patients. Conclusions LASIK-induced rose bengal staining in patients without preexisting dry eye is likely neurotrophic epitheliopathy, because there is no difference in mean tear production between patients who have significant Punctate Epithelial Erosions and rose bengal staining develop on the flap and those who do not. The signs and symptoms of LASIK-induced (presumed) neurotrophic epitheliopathy tend to resolve approximately 6 months after surgery. This disorder tends to be more common and severe in patients with pre-existing dry eye disease.
Ali R. Djalilian - One of the best experts on this subject based on the ideXlab platform.
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Limbitis Secondary to Autologous Serum Eye Drops in a Patient with Atopic Keratoconjunctivitis
Case reports in ophthalmological medicine, 2011Co-Authors: Jeffrey D. Welder, Pejman Bakhtiari, Ali R. DjalilianAbstract:Purpose. Report a case of limbitis secondary to autologous serum eye drops in a patient with atopic keratoconjunctivitis. Design. Interventional case report. Methods. A 32-year-old African American female with atopic keratoconjunctivitis (AKC) presented with chronic dry eye and diffuse Punctate Epithelial Erosions refractory to conservative treatment. She was initially managed with cyclosporine ophthalmic 0.05% in addition to preservative-free artificial tears and olopatadine hydrochloride 0.2% for 6 months. She was later placed on autologous serum eye drops (ASEDs) and 4 weeks into treatment developed unilateral limbitis. The limbitis resolved shortly after stopping ASEDs in that eye; however, the drops were continued in the contralateral eye, which subsequently developed limbitis within 2 weeks. ASEDs were discontinued in both eyes, and the patient has remained quiet ever since. Results. Patient with a history of AKC and no prior history of limbitis developed limbitis shortly after starting ASEDs, which resolved promptly after discontinuation of therapy with no subsequent recurrence of inflammation. Conclusion. ASEDs are widely used in the treatment of complicated or treatment refractory dry eye. The potential side effects should be kept in mind when prescribing ASEDs for any patient, especially in those with underlying immunological diseases and circulating inflammatory factors.
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Limbitis Secondary to Autologous Serum Eye Drops in a Patient with Atopic Keratoconjunctivitis
2011Co-Authors: Jeffrey D. Welder, Pejman Bakhtiari, Ali R. DjalilianAbstract:License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. Report a case of limbitis secondary to autologous serum eye drops in a patient with atopic keratoconjunctivitis. Design. Interventional case report. Methods. A 32-year-old African American female with atopic keratoconjunctivitis (AKC) presented with chronic dry eye and diffuse Punctate Epithelial Erosions refractory to conservative treatment. She was initially managed with cyclosporine ophthalmic 0.05 % in addition to preservative-free artificial tears and olopatadine hydrochloride 0.2 % for 6 months. She was later placed on autologous serum eye drops (ASEDs) and 4 weeks into treatment developed unilateral limbitis. The limbitis resolved shortly after stopping ASEDs in that eye; however, the drops were continued in the contralateral eye, which subsequently developed limbitis within 2 weeks. ASEDs were discontinued in both eyes, and the patient has remained quiet ever since. Results. Patient with a history of AKC and no prior history of limbitis developed limbitis shortly after starting ASEDs, which resolved promptly after discontinuation of therapy with no subsequent recurrence of inflammation. Conclusion. ASEDs are widely used in the treatment of complicated or treatment refractory dry eye. The potential side effects should be kept in mind when prescribing ASEDs for any patient, especially in those with underlying immunological diseases and circulating inflammatory factors. 1
Ben J Glasgow - One of the best experts on this subject based on the ideXlab platform.
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fluorescein Punctate staining traced to superficial corneal Epithelial cells by impression cytology and confocal microscopy
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Maryam Mokhtarzadeh, Richard Casey, Ben J GlasgowAbstract:Definitions of dry eye and estimation of the severity often include the quantity and distribution of fluorescent Punctate stains of the cornea.1–3 The phenomenon, superficial Punctate fluorescence, is found in apparently normal subjects,4–8 contact lens wearers,9,10 and dry eyes.11–14 Synonymous terms, such as Punctate Epithelial Erosions and Punctate Epithelial defects, imply loss of Epithelial cells, but the anatomic basis is controversial and unproven.6,15,16 Punctate staining can be transient, appearing and disappearing over a matter of hours.17,18 Superficial Punctate staining can be reduced by a high-humidity atmosphere, punctal plugging, artificial tears, and anti-inflammatory treatments.9,19–25 There is a strong correlation between the distribution of Punctate stains in both eyes of a single individual, suggesting a systemic or environmental etiology, rather than a strictly local cause.18,19 Smoking, hormone changes, and medications have all been linked to changes in Punctate corneal staining.26–29 The main hypothesis for Punctate staining has several components. First, intercellular gaps, created by loss of tight junction integrity allow deep penetration and trapping of fluorescein between cells6,18,30–33; second, fluorescein stains desquamating, damaged, or dead cells19,30,34,35; third, surface irregularities or defects left by an absence of cells cause fluorescein to pool in Punctate areas.13,18,36–39 However, irrigation does not easily remove the fluorescent Punctate stains, and so pooling over surface irregularities is unlikely.40,41 Studies in rabbits and humans suggest that both living and dead cells take in fluorescein, although not all cells with fluorescein uptake are visible under the slit lamp microscope.35,42,43 The evidence that uptake is intracellular was based solely on the size and shape of the fluorescein staining spots, because organelle stains were not used.35,40 The goal of this study was to investigate the cellular basis of Punctate staining by using confocal microscopy in conjunction with optimized impression cytology techniques.
Anat Galor - One of the best experts on this subject based on the ideXlab platform.
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Parallel ocular and serologic course in a patient with early Sjogren's syndrome markers
Elsevier, 2017Co-Authors: Lam Phung, Ivonne V. Lollett, Raquel Goldhardt, Janet L. Davis, Larry Young, Dana Ascherman, Anat GalorAbstract:Purpose: To report on a case of a young female with progressing dry eye symptoms and evolving autoimmune markers consistent with a presentation of early Sjogren's syndrome (SS). Observations: A 32 year-old female presented with chronic dry eye symptoms refractory to artificial tears. Slit lamp examination revealed Punctate Epithelial Erosions, decreased tear break-up time, and decreased tear lake bilaterally. Initial tests for ocular surface inflammation (InflammaDry, Quidel, San Diego) and systemic autoantibodies (antinuclear antibodies, anti-SSA/Ro and anti-SSB/La) were negative. After 4 months of persistent ocular symptoms and signs, ocular surface inflammation was detected via InflammaDry and blood results included a positive antinuclear antibody (1:160), rheumatoid factor (IgG 25.3 EU/ml), and carbonic anhydrase 6 (IgM 20.2 EU/ml), but persistently negative anti-SSA/Ro and anti-SSB/La antibodies. Conclusions and importance: Taken together, these findings were suggestive of early Sjogren's syndrome with simultaneous appearance of both ocular and serum biomarkers. Novel autoantibodies testing in suspected patients can guide early intervention and potentially improve both the glandular and extra-glandular function in patients
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brimonidine allergy presenting as vernal like keratoconjunctivitis
Journal of Glaucoma, 2015Co-Authors: Aparna A Shah, Yasha S Modi, Benjamin J Thomas, Sarah R Wellik, Anat GalorAbstract:Purpose To report a brimonidone-induced allergic reaction that mimicked a limbal form of vernal keratoconjunctivitis in the setting of background ocular surface toxicity. Patients and methods A 78-year-old male with a history of primary open angle glaucoma presented with symptoms of unilateral blurry vision, irritation, and redness shortly after starting brimonidine exclusively in the right eye. Examination revealed injected palpebral and bulbar conjunctiva, diffuse Punctate Epithelial erosion and discrete, non-staining corneal limbal infiltrates superiorly. Results Given the unilateral presentation, the patient was diagnosed with an allergic limbal keratoconjunctivitis secondary to bromonidine. Shortly after discontinuing the brimonidine, there was full resolution of the corneal limbal infiltrates. The Punctate Epithelial Erosions and tear film abnormalities remained. Conclusion Direct medication allergy and ocular surface disease are two distinct entities that often co-exist. Distinguishing between the two entities, sometimes by trial and error, is critical in the management of these patients.
Jeffrey D. Welder - One of the best experts on this subject based on the ideXlab platform.
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Limbitis Secondary to Autologous Serum Eye Drops in a Patient with Atopic Keratoconjunctivitis
Case reports in ophthalmological medicine, 2011Co-Authors: Jeffrey D. Welder, Pejman Bakhtiari, Ali R. DjalilianAbstract:Purpose. Report a case of limbitis secondary to autologous serum eye drops in a patient with atopic keratoconjunctivitis. Design. Interventional case report. Methods. A 32-year-old African American female with atopic keratoconjunctivitis (AKC) presented with chronic dry eye and diffuse Punctate Epithelial Erosions refractory to conservative treatment. She was initially managed with cyclosporine ophthalmic 0.05% in addition to preservative-free artificial tears and olopatadine hydrochloride 0.2% for 6 months. She was later placed on autologous serum eye drops (ASEDs) and 4 weeks into treatment developed unilateral limbitis. The limbitis resolved shortly after stopping ASEDs in that eye; however, the drops were continued in the contralateral eye, which subsequently developed limbitis within 2 weeks. ASEDs were discontinued in both eyes, and the patient has remained quiet ever since. Results. Patient with a history of AKC and no prior history of limbitis developed limbitis shortly after starting ASEDs, which resolved promptly after discontinuation of therapy with no subsequent recurrence of inflammation. Conclusion. ASEDs are widely used in the treatment of complicated or treatment refractory dry eye. The potential side effects should be kept in mind when prescribing ASEDs for any patient, especially in those with underlying immunological diseases and circulating inflammatory factors.
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Limbitis Secondary to Autologous Serum Eye Drops in a Patient with Atopic Keratoconjunctivitis
2011Co-Authors: Jeffrey D. Welder, Pejman Bakhtiari, Ali R. DjalilianAbstract:License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. Report a case of limbitis secondary to autologous serum eye drops in a patient with atopic keratoconjunctivitis. Design. Interventional case report. Methods. A 32-year-old African American female with atopic keratoconjunctivitis (AKC) presented with chronic dry eye and diffuse Punctate Epithelial Erosions refractory to conservative treatment. She was initially managed with cyclosporine ophthalmic 0.05 % in addition to preservative-free artificial tears and olopatadine hydrochloride 0.2 % for 6 months. She was later placed on autologous serum eye drops (ASEDs) and 4 weeks into treatment developed unilateral limbitis. The limbitis resolved shortly after stopping ASEDs in that eye; however, the drops were continued in the contralateral eye, which subsequently developed limbitis within 2 weeks. ASEDs were discontinued in both eyes, and the patient has remained quiet ever since. Results. Patient with a history of AKC and no prior history of limbitis developed limbitis shortly after starting ASEDs, which resolved promptly after discontinuation of therapy with no subsequent recurrence of inflammation. Conclusion. ASEDs are widely used in the treatment of complicated or treatment refractory dry eye. The potential side effects should be kept in mind when prescribing ASEDs for any patient, especially in those with underlying immunological diseases and circulating inflammatory factors. 1
