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Publications (6)17.02 Total impact

  • [Show abstract] [Hide abstract] ABSTRACT: To correlate clinical, impression cytologic, and in vivo confocal microscopy findings on the corneal surface after cultured limbal stem cell transplantation. Prospective, interventional, noncomparative, masked case series. Thirteen patients with limbal stem cell deficiency after unilateral (9 eyes) or bilateral (2 eyes) chemical burn, liquid nitrogen injury (1 eye), or herpes simplex virus infection (1 eye). Limbal cells were harvested from healthy or less affected eyes, cultured on 3T3 cells and fibrin glue, and transplanted to the patient's injured eye. Patients underwent clinical examination and impression cytologic examination of the central cornea before and 1 year after intervention. In vivo confocal microscopy scans were obtained in all corneal quadrants after 1 year. The interexamination agreement was established by calculation of the Cohen's κ coefficient. Results of surgery were assessed considering clinical signs (successful: restoration of transparent, avascular, and stable corneal epithelium without neovascularization in central corneal surface; partially successful: recurrence of superficial neovascularization; failed: recurrent epithelial defects, pannus, and inflammation), phenotype of cells covering the corneal surface (conjunctivalized corneal surface: cytokeratin 12 [cK12]-negative and mucin 1 [MUC1]-positive cells; mixed epithelium: cK12-positive and MUC1-positive cells; corneal epithelium: cK12-positive and MUC1-negative cells), and cell morphologic features (corneal epithelium: multilayered polygonal and flat cells with hyperreflective nuclei; conjunctival epithelium: stratified cuboidal or polygonal cells, hyperreflective cytoplasm, and barely defined borders; epithelial transition: transition of epithelial cells from the cornea to the conjunctiva over the corneal surface). We found a moderate to substantial degree of concordance between confocal microscopy and clinical evaluation (κ = 0.768) and between confocal microscopy and impression cytologic analysis (κ = 0.629). Confocal microscopy showed that 46.2% of patients exhibited corneal epithelium in the central and peripheral cornea, 30.8% showed an irregular mixed corneal and conjunctival epithelium, and 23.0% showed conjunctival epithelium. Palisades of Vogt were absent in all (100.0%) patients, and the cornea-conjunctiva epithelial transition localized approximately 1 mm internally on the cornea. Confocal microscopy provides objective measures of the corneal epithelium and may significantly improve the evaluation of outcomes after cultured limbal stem cell graft. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · Ophthalmology
  • [Show abstract] [Hide abstract] ABSTRACT: To evaluate the visual outcome, spectacle independence, and patient satisfaction after implantation of two Acrysof ReSTOR (Alcon Laboratories, Inc., Fort Worth, TX) intraocular lenses (IOLs) with different addition power or their combination in both eyes. One hundred twenty eyes of 60 patients with bilateral multifocal IOL implantation were divided into three groups of 20 consecutive patients each: the SV25T0 (the T0 group), the SN6AD1 (the D1 group), or a combination of both the SN6AD1 and SV25T0 (the combined group). Patients were observed 18 months postoperatively for visual acuity (40, 50, and 60 cm, and 4 m), defocus curves (range: +1.0 to -4.0 diopters), and contrast sensitivity. Quality of vision, patient satisfaction, and spectacle independence were evaluated by the National Eye Institute Refractive Error Quality of Life Instrument-42 questionnaire. The D1 group achieved better results for near vision (P < .01), whereas the T0 group achieved better intermediate vision (P = .01). The combined group showed a wider range of spectacle independence at all distances evaluated (P < .05). The contrast sensitivity was similar within the groups. The incidence of glare was lower for the T0 group (P = .054). The combined group had better results in terms of expectation (P = .021) and activity limitation (P = .003). Although the bilateral implantation of the same multifocal IOL can maximize the vision for near or intermediate distances, the combination of these IOLs in both eyes can increase the range of spectacle independence without compromising the contrast sensitivity and quality of vision. [J Refract Surg. 2015;31(5):308-314.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · May 2015 · Journal of refractive surgery (Thorofare, N.J.: 1995)
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: To evaluate monocular functional outcomes after the implantation of the AcrySof ReSTOR SN6AD2 intraocular lens (IOL) (+2.5 diopters [D] near add) (Alcon Laboratories, Inc., Fort Worth, TX) and the AcrySof ReSTOR SN6AD1 IOL (+3.0 D near add) (Alcon Laboratories, Inc.). Methods: This prospective, comparative, nonrandomized single-blind observational study comprised 62 eyes of 62 patients that underwent phacoemulsification and implantation of a multifocal IOL: SN6AD2 (31 eyes) (+2.5 group) and SN6AD1 (31 eyes) (+3.0 group). Twelve months after surgery, monocular near (30 and 40 cm), intermediate (50, 60, and 70 cm), and distance (4 m) visual acuity were evaluated with the internal root mean square and modulation transfer function. Both parameters were evaluated at the 4- and 6-mm pupil sizes. Results: No statistical differences at 4 m were found between the groups. The +2.5 group obtained better performances at all intermediate distances (50 cm, 0.23 ± 0.14 vs 0.32 ± 0.13; 60 and 70 cm, 0.21 ± 0.10 vs 0.41 ± 0.14 and 0.24 ± 0.10 vs 0.53 ± 0.17, respectively), whereas the near visual acuity was better for the +3.0 group (30 and 40 cm, 0.36 ± 0.18 vs 0.14 ± 0.09 and 0.36 ± 0.19 vs 0.17 ± 0.07, respectively). The root mean square was lower for the +2.5 group compared to the +3.0 group, whereas the modulation transfer function showed overlapping results between the two models. Conclusions: Both IOL models showed good results in distance vision; the +2.5 D IOL seemed to provide better intermediate vision than the +3.0 D IOL. For near vision, the +3.0 D model performed better than the +2.5 D model.
    No preview · Article · Nov 2014 · Journal of refractive surgery (Thorofare, N.J.: 1995)
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    [Show abstract] [Hide abstract] ABSTRACT: We describe a case of fungal keratitis due to Beauveria bassiana in a farmer with Fuchs' dystrophy, treated with amphotericin B. Surgery with penetrating keratoplasty was necessary to resolve the lesions. Susceptibility testing and molecular sequencing permitted the identification and treatment of this rare aetiological agent of invasive fungal disease.
    Full-text · Article · Apr 2014
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    [Show abstract] [Hide abstract] ABSTRACT: To compare higher order aberrations (HOAs) caused by the anterior and posterior corneal surfaces after conventional penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and automated lamellar therapeutic keratoplasty (ALTK) in patients undergoing corneal transplantation for keratoconus (KC). This retrospective, observational, cross-sectional study included one eye of the following subjects: 40 patients with KC, 23 KC patients after PK, 17 KC patients after DALK, 18 KC patients after ALTK, and 38 healthy controls. All underwent imaging with a rotating Scheimpflug camera (at least 6 months after complete suture removal in grafted subjects) to assess the HOAs from the anterior and posterior corneal surfaces within the central 4-mm and 6-mm zones. The conversion of the corneal elevation profile into corneal wavefront data was performed using Zernike polynomials. Total and third- and fourth-order HOAs were considered. The root mean square of the Zernike vector magnitude, expressed in micrometers, was used. Differences among groups were assessed using the Kruskal-Wallis and Duncan multiple range tests. Statistical significance was defined as p < 0.05. In both 4-mm and 6-mm central zones, the total HOAs from the anterior corneal surfaces were significantly lower in DALK than in ALTK and PK groups (p < 0.05). The total HOAs from the posterior corneal surface were comparable amongst postoperative groups (p > 0.05). The aberration components that were significantly greater included coma in the KC and ALTK eyes, trefoil and coma in the DALK eyes, and trefoil in the PK eyes. The corneal anterior surface optical quality appeared significantly better after DALK than after ALTK and PK.
    Full-text · Article · Mar 2013 · Optometry and vision science: official publication of the American Academy of Optometry
  • [Show abstract] [Hide abstract] ABSTRACT: Chemical burns cause depletion of limbal stem cells and eventually lead to corneal opacity and visual loss. We investigated the long-term effectiveness of autologous cultured limbal stem cell grafts in patients with limbal stem cell deficiency. Prospective, non-comparative interventional case series. Sixteen eyes from 16 patients with severe, unilateral limbal stem cell deficiency caused by chemical burns. Autologous ex vivo cultured limbal stem cells were grafted onto the recipient eye after superficial keratectomy. Clinical parameters of limbal stem cell deficiency (stability/transparency of the corneal epithelium, superficial corneal vascularization and pain/photophobia), visual acuity, cytokeratin expression on impression cytology specimens and histology on excised corneal buttons. At 12 months post-surgery, evaluation of the 16 patients showed that 10 (62.6%) experienced complete restoration of a stable and clear epithelium and 3 (18.7%) had partially successful outcomes (re-appearance of conjunctiva in some sectors of the cornea and instable corneal surface). Graft failure (no change in corneal surface conditions) was seen in three (18.7%) patients. Penetrating keratoplasty was performed in seven patients, with visual acuity improving up to 0.8 (best result). For two patients, regeneration of the corneal epithelium was confirmed by molecular marker (p63, cytokeratin 3, 12 and 19, mucin 1) analysis. Follow-up times ranged from 12 to 50 months. Grafts of autologous limbal stem cells cultured onto fibrin glue discs can successfully regenerate the corneal epithelium in patients with limbal stem cell deficiency, allowing to perform successful cornea transplantation and restore vision.
    No preview · Article · Jun 2011 · Clinical and Experimental Ophthalmology