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Few studies have provided epidemiological characteristics of childhood glaucoma in a large, multiethnic population. This information is important if we are to better screen for and characterize this specific type of glaucoma. In this study, we evaluate the characteristics of patients with childhood glaucoma, including glaucoma suspects, as identified through the Dallas Glaucoma Registry (DGR). The DGR catalogs the characteristics of glaucoma patients seen at University of Texas Southwestern Medical Center, an academic tertiary referral center for a large, multiethnic, urban population in the United States. We analyzed these patients with respect to race, medical and surgical treatment, cup-to-disc ratio, intraocular pressure, and visual outcomes. The study comprised 376 eyes of 239 childhood glaucoma patients, of whom 19% had primary congenital glaucoma, 4% had primary juvenile glaucoma, 45% had secondary glaucoma, and 31% were glaucoma suspects. Trauma and postsurgical aphakia were the most common causes for secondary glaucoma. Thirty-eight percent of patients were Hispanic, 30% were Caucasian, 21% were African American, 3% were Asian, and 9% were unknown or unreported. Male sex was more common at 56%. Of all eyes with glaucoma, 65% received surgical intervention while 70% required at least one medication for intraocular pressure control. Trabeculotomy and tube-shunt surgery were the most common surgeries performed. Of patients who could have Snellen visual acuity measured, glaucoma suspect eyes had the largest proportion of eyes (96%) with good visual acuity (better than 20/40) while primary congenital glaucoma eyes had the smallest proportion (41%) with good visual acuity. Secondary glaucoma eyes had the largest proportion of eyes (30%) with poor visual acuity (worse than count fingers). The most common etiologies of childhood glaucoma were primary congenital glaucoma and secondary causes including trauma and postsurgical aphakia. A high proportion of glaucoma patients were of Hispanic background, reflecting the patient population studied. Trabeculotomy and tube-shunt surgery were the most common surgical interventions performed.

To review and integrate recent advances in identifying the role of inflammation in the pathogenesis of dry eye conditions and the biological rationale and practical clinical aspects of newer, antiinflammatory theories. A comprehensive literature survey. Keratoconjunctivitis Sicca (KCS) is a multifactorial and complex disorder in which ocular surface inflammations play a central role. Identification of specific CD4-T-Cell pathways and the recent recognition of targeting of alpha-fodrin suggest a case for novel new therapeutic aspects such as anti-CD4 monoclonal antibodies, systemic linoleic and gamma-linolenic acids, and omega-6 essential fatty acids. Replacement of tear volume with nonpreserved wetting agents and standard typical antiinflammatory corticosteroid and/or cyclosporine A continues to be central current conventional therapy for KCS.

Donors screened by medical social history interview negative for high risk behavior or communicable disease history, but subsequently exhibiting reactive serological markers, emphasize importance of duel safe guarding factors for determining donor suitability. This report examines a relationship between two immunoabsorption assay tests, hepatitis B core (HBc) antibody, a required food and drug administration (FDA) test, and hepatitis B antibody (anti HBs), non-required test. Reactive serology results, 129 cases, 3,581 donors (2008–2012) for HBc as the only initially positive serological marker were subjected to anti HBs testing in this history pre-screened donor population. Enzyme linked immunoabsorption assay kits hepatitis B, core and antibody, were used in this study. All samples were initially tested for human immunodeficiency virus, hepatitis B, and hepatitis C, utilizing nucleic acid testing and antigen antibody immunoabsorption assay. Testing was performed by a FDA-registered CLEA-certified reference laboratory. Samples were deceased donor blood samples and a limited number of pre-mortem samples, separated, stored and analyzed according to manufacturer recommendation and FDA regulations. 129 reactive HBc only samples, were subsequently tested for anti HBs. Of these 129, 94 were found to be reactive for anti HBs. This represented 72 % of samples tested for antibody, a higher percentage than anticipated for a medical history negative, low risk population.

To quantify the long-term outcomes of congenital glaucoma and surgical success rates following pseudo 360-degree trabeculotomy surgery at Children's Medical Center in Dallas. An International Classification of Diseases (ICD-9) database was utilized for a retrospective chart review. Thirty-eight eyes of 24 who underwent primary trabeculotomy with a pseudo 360-degree technique between June 1, 1992 and December 31, 2005 were studied. Mean age at the time of trabeculotomy was 11.1 ± 3.0 months, with seven eyes operated on after 1 year of age. Mean follow-up was 85.1 ± 9.0 months. Mean intraocular pressure (IOP) at the time of glaucoma diagnosis was 32.7 ± 1.1 mmHg, and final mean IOP for all eyes (after trabeculotomy and any additional surgery and/or glaucoma medications) was 17.9 ± 0.8 mmHg. With trabeculotomy and medication alone, mean final IOP was 19.9 ± 1.1 mmHg, with a mean drop in IOP of 12.5 ± 1.4 mmHg. Surgical success, defined by adequate IOP control, was achieved in 30 eyes (78.96%) at most recent follow-up. Kaplan-Meier analysis demonstrated 5- and 10-year survival probabilities of 93.1% and 66.8%, respectively. Seventeen eyes (44.7% of all eyes) achieved complete success, meaning IOP control <21 mmHg without additional medical therapy. All seventeen had primary congenital glaucoma (PCG); no eyes with aphakic glaucoma (AG) or Sturge-Weber syndrome (SWS) achieved complete success. Seven eyes (18.4%) failed primary trabeculotomy. Mean time to failure was 46.9 ± 8.6 months. Eyes with SWS had a significantly higher failure rate (P = 0.009) and a 5.81 relative risk of failure (P = 0.026). Our long-term trabeculotomy success rates for congenital glaucoma compare favorably with existing reports in the literature. Eyes with AG and SWS may warrant consideration of alternative primary surgical methods, or closer postoperative surveillance.

Microbial keratitis (MK) is the most visually devastating complication associated with contact lens wear. Pseudomonas aeruginosa (PA) is highly invasive in the corneal epithelium and is responsible for more than half of the reported cases of contact lens-related MK. To protect against Pseudomonas-mediated MK, the corneal epithelium has evolved overlapping defense mechanisms that function to protect the ocular surface from microbial invasion. Research has shown that contact lens wear disrupts these protective mechanisms through breakdown of normal homeostatic surface renewal as well as damaging the corneal surface, exposing underlying cell membrane receptors that bind and internalize PA through the formation of lipid rafts. Human clinical trials have shown that initial adherence of PA with resulting increased risk for microbial infection is mediated in part by contact lens oxygen transmissibility. Recently, chemical preserved multipurpose solutions (MPS) have been implicated in increasing PA adherence to corneal epithelial cells, in addition to inducing significant levels of toxic staining when used in conjunction with specific silicone hydrogel lenses. This review summarizes what is currently known about the relationship between contact lenses, the corneal epithelium, MPS, and infection.

Purpose To evaluate the efficacy of the aspheric optic of the AcrySof IQ SN60WF intraocular lens (IOL) in decreasing spherical and total higher order aberrations and improving contrast sensitivity after cataract surgery compared to the spheric AcrySof SN60AT. Methods Fifty-two eyes of 36 patients were evaluated at the University of Texas Southwestern Medical Center at Dallas 3 to 6 months after phacoemulsification with implantation of the AcrySof IQ SN60WF (27 eyes) or AcrySof SN60AT (25 eyes) IOL. Eyes with previous surgery or ocular pathology were excluded. Results Eyes implanted with the AcrySof IQ SN60WF had less total higher order and spherical aberrations than AcrySof SN60AT-implanted eyes at pupils of 4 mm (0.14±60.06 vs 0.18±0.04 µm and −0.01±0.03 vs 0.09±0.03 µm, respectively), 5 mm (0.24±0.07 vs 0.34±0.08 µm and 0.03±0.02 vs 0.23±0.08 µm, respectively), and 6 mm (0.42±0.13 vs 0.67±0.12 µm and 0.08±0.04 and 0.46±0.09 µm, respectively), (P<.05 for all), with similar mean coma, trefoil, and 5th order aberrations. AcrySof SN60WF eyes showed better contrast sensitivity than AcrySof SN60AT eyes at 12 and 18 cycles per degree (cpd) under mesopic conditions (1.65±0.23 vs 1.51±0.25 and 1.22±0.21 vs 1.01±0.19, respectively), and at 18 cpd under glare (1.12±0.30 vs 0.87±0.31, respectively) (P<.05). Photopic contrast sensitivity was similar in both groups. The two groups had comparable mean age, axial length, IOL power, and postoperative mesopic and photopic pupil sizes. Conclusions Compared to a spheric optic, the aspheric design of the AcrySof IQ SN60WF reduces spherical aberration, especially under larger pupil sizes, and improves mesopic contrast sensitivity at higher frequencies with and without glare. [J Refract Surg. 2008;24:619–625.]

ABSTRACTPURPOSE: To evaluate and compare the visual and clinical outcomes of wavefront-guided laser in situ keratomileusis (LASIK) with the Alcon CustomCornea (Alcon Laboratories Inc, Fort Worth, Tex) and VISX CustomVue (VISX, Santa Clara, Calif) systems.METHODS: Ninety-three eyes of 56 patients (50 and 43 consecutive eyes on CustomCornea and CustomVue, respectively) were enrolled in a prospective multisurgeon clinical outcome study. Uncorrected visual acuity (UCVA), best spectaclecorrected visual acuity (BSCVA), and manifest refraction were measured at 1 day, 1 week, 1 month, and 3 months postoperatively. Early treatment diabetic retinopathy study (ETDRS) visual acuity and contrast sensitivity were measured at 1 month and 3 months, and wavefront mapping at 3 months.RESULTS: Preoperatively, the CustomCornea group had a mean sphere of -3.90 ? 1.62 diopters (D) (range -0.50 to -7.25 D), mean cylinder of +0.62 ? 0.39 D (range 0 to +1.50 D), and mean manifest spherical equivalent refraction of -3.59 ? 1.54 D. The CustomVue group had a sphere of -3.87 ? 1.45 D (range -1.75 to -6.75 D), cylinder of +0.49 ? 0.36 D (range 0 to +1.50 D), and manifest spherical equivalent refraction of -3.62 ? 1.46 D. At 3 months, 98% of the CustomCornea group and 95% of the CustomVue group were within ?0.50 D. Ninety -nine percent of eyes did not change >0.50 D (manifest spherical equivalent refraction) between 1 month and 3 months. CustomCornea eyes improved on contrast sensitivity testing and had a better profile than CustomVue for 20/15 Snellen and 20/12.5 ETDRS acuity. Both laser groups had a decrease in higher order aberrations with statistical significance for coma and spherical aberration in the CustomCornea group.CONCLUSION: Wavefront-guided LASIK with both systems is safe and effective. [J Refract Surg 2004;20:S636-S643]

Purpose: To evaluate the objective and subjective visual outcomes and refractive results of wavefront-guided LASIK with LADAR CustomCornea and VISX CustomVue. Methods: This prospective randomized single-institution multisurgeon study comprised 100 eyes of 58 patients (50 eyes on each laser platform). Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and manifest refraction were measured postoperatively at 1 day, 1 week, 1 month, and 3 months. Contrast sensitivity, higher order aberrations measurement, and a subjective vision questionnaire were performed preoperatively and at 3 months. Results: Preoperatively, the CustomCornea group had a mean manifest sphere of −3.58±1.61 diopters (D) (range: −0.50 to −7.25 D), cylinder of +0.64±0.45 D (range: 0 to +1.75 D), and manifest refractive spherical equivalent (MRSE) of −3.26±1.56 D. The Custom-Vue group had a manifest sphere of −4.00±1.69 D (range: −1.50 to −7.50 D), cylinder of +0.60±0.52 D (range: 0 to +2.00 D), and MRSE of −3.70±1.64 D. At 3 months, 94% of CustomCornea eyes and 84% of CustomVue eyes had UCVA ⩾20/20 (P=.20). Twenty-four percent of CustomVue eyes and 22% of Custom-Cornea eyes gained 1 line of BSCVA. In both groups, 96% of eyes were within 0.50 D of emmetropia. Mean CustomCornea glare contrast sensitivity improved (P=.04) whereas more eyes improved than worsened in both groups. Spherical aberration and total higher order aberrations increased, and trefoil decreased in both groups. A decrease in coma was noted in 70% of CustomCornea eyes. Conclusions: Wavefront-guided LASIK with both platforms is safe, effective, and delivers excellent visual results. CustomCornea improves contrast sensitivity under glare conditions. [J Refract Surg. 2007;23:26–38.]

Purpose To assess the response of corneal keratocytes to the IntraLase FS60 femtosecond laser using attenuated steroids. Methods Thirty patients (30 eyes) who underwent LASIK with the IntraLase FS60 were assessed by clinical examination and confocal microscopy 3 months postoperatively. Postoperative steroid regimen was Econopred Plus (Alcon Laboratories Inc) every hour for 1 day and four times daily for 7 days. Results No cornea had clinically significant flap interface haze. Two corneas had trace haze at the interface detected by slit-lamp examination; both showed significant keratocyte activation by confocal microscopy. Overall, some degree of keratocyte activation was detected at the flap interface in 10 of 30 eyes. The measured interface reflectivity was 328.8±85.0 confocal backscatter units (CBU) in eyes with activated keratocytes and 88.9±74.5 CBU for the remaining 19 eyes (P<.001). Conclusions With attenuated steroids, keratocyte activation was found in a significant number of eyes, although interface haze was subclinical. A higher steroid dosage might therefore be indicated. [J Refract Surg. 2008;24:847–849.]

Although it is known that cells promote structural reorganization of the collagen architecture, how individual cells exert mechanical tension on the matrix is not clearly understood. In the present study we have investigated the mechanical interaction of individual corneal fibroblasts with a collagen matrix using an improved version of our previously described in vitro force-measurement system (Roy, P. et al. Exp. Cell Res. 232:106-117, 1997). The elastic distortion of the collagen matrix exerted by cells was temporally recorded and analyzed using a two-dimensional finite-element model to quantify the forces exerted on the matrix. Time-lapse videomicroscopy of serum-cultured cells on the matrix for up to 6 h revealed that individual fibroblasts generated measurable tension on the matrix during pseudopodial extension and slow retraction. Fast retraction, an event observed during active cell migration, was associated with dramatic release of tension on the matrix. An apparent inverse correlation was observed between cell translocation and maintenance of matrix tension. Additional experiments with cells under serum-free conditions revealed that these cells fail to generate any detectable tension on the matrix despite undergoing filopodial extension and retraction. Since serum-free cells do not form focal adhesions or stress fibers, these experimental data suggest that contractility of nonmotile cells, coupled with strong cell-matrix adhesion, is the most favorable mechanism of generating and maintaining tension on the extracellular matrix.