Cornea and External Eye Disease

244 Pages·2008·4.991 MB·English

by  Leejee H. Suh, M. Vaughn Emerson (auth.), Thomas Reinhard, Frank Larkin (eds.)

Essentials in Ophthalmology Cornea and External Eye Disease
T. Reinhard F. Larkin
Editors
Essentials in Ophthalmology Glaucoma
G. K. Krieglstein R. N. Weinreb Cataract and Refractive Surgery
Series Editors
Uveitis and Immunological Disorders
Vitreo-retinal Surgery
Medical Retina
Oculoplastics and Orbit
Pediatric Ophthalmology,
Neuro-Ophthalmology, Genetics
Cornea and External Eye Disease
Editors Thomas Reinhard
Frank Larkin
Cornea
and External
Eye Disease
With 103 Figures, Mostly in Colour
and 14 Tables
123
Series Editors Volume Editors
Günter K. Krieglstein, MD Thomas Reinhard, MD
Professor and Chairman Klinikum Augenheilkunde
Department of Ophthalmology Universität Freiburg
University of Cologne Killianstraße 5
Kerpener Straße 62 79106 Freiburg
50924 Cologne Germany
Germany
Frank Larkin, MD
Robert N. Weinreb, MD Moorfields Eye Hospital
Professor and Director City Road 162
Hamilton Glaucoma Center London, EC1V 2PD
Department of Ophthalmology UK
University of California at San Diego
9500 Gilman Drive
La Jolla, CA 92093-0946
USA
ISBN 978-3-540-33680-8 ISSN 1612-3212
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Foreword
The series Essentials in Ophthalmology was initi- to discuss clinically relevant and appropriate top-
ated two years ago to expedite the timely trans- ics. Summaries of clinically relevant information
fer of new information in vision science and have been provided throughout each chapter.
evidence-based medicine into clinical practice. Each subspecialty area now has been covered
We thought that this prospicient idea would be once, and the response to the first eight volumes
moved and guided by a resolute commitment in the series has been enthusiastically positive.
to excellence. It is reasonable to now update our With the start of the second cycle of subspecialty
readers with what has been achieved. coverage, the dissemination of practical informa-
The immediate goal was to transfer informa- tion will be continued as we learn more about
tion through a high quality quarterly publication the emerging advances in various ophthalmic
in which ophthalmology would be represented by subspecialties that can be applied to obtain the
eight subspecialties. In this regard, each issue has best possible care of our patients. Moreover, we
had a subspecialty theme and has been overseen will continue to highlight clinically relevant in-
by two internationally recognized volume edi- formation and maintain our commitment to ex-
tors, who in turn have invited a bevy of experts cellence.
G. K. Krieglstein
R. N. Weinreb
Series Editors
Preface
The second volume covers a broad range of con- Molecular genetic evidence of corneal dystro-
junctival and corneal diseases, again with par- phies is fascinating and has led to a completely
ticular emphasis being placed on problem man- new classification.
agement. The chapter on corneal preservation shows the
Various new surgical approaches are currently challenge for tissue banking behind the new
being evaluated in the clinical setting, an exam- surgical approaches. Inflammatory diseases of
ple of which is posterior lamellar keratoplasty in the cornea and conjunctiva remain a continuing
Fuchs endothelial disease. While amniotic mem- challenge in every external eye disease clinic, de-
brane transplantation has been in use for some scribed in the chapters on herpes simplex kerati-
years and for a range of indications, it is now tis, ocular pemphigoid, adult inclusion conjunc-
becoming more and more popular for the treat- tivitis, and chronic blepharitis. Understanding
ment of ulceration in infectious keratitis. Tis- of the biology of conjunctival melanoma is im-
sue-engineered scaffolds as templates for corneal proving and confocal microscopy may become
reconstruction are being investigated for possible established as a new diagnostic aid and follow-up
future surgical approaches. Phototherapeutic technique.
keratectomy has been established for some years
in the therapeutic repertoire for various phe- We hope you enjoy reading this book.
notypes of corneal dystrophy: this intervention
is now safe and effective in many patients with
superficial dystrophic corneal opacities or recur- Thomas Reinhard
rent erosion. Frank Larkin
Contents
Chapter 1 2.2.3.1 Clinical Features ............ 20
Fuchs Endothelial Dystrophy: 2.2.3.2 Treatment ................. 20
Pathogenesis and Management 2.3 Pathogenesis of Corneal
Ulceration ................. 20
Leejee H. Suh, M. Vaughn Emerson,
2.3.1 Pathogenesis of Corneal
Albert S. Jun
HSV-1 Ulceration ........... 20
1.1 Introduction ............... 2 2.3.1.1 Necrotizing Stromal Keratitis 20
1.2 Historical Perspective ....... 2 2.3.1.2 Neurotrophic Keratopathy .. 21
1.3 Epidemiology and 2.3.2 Pathogenesis of Corneal
Inheritance ................ 2 Bacterial Ulceration ......... 21
1.4 Pathology ................. 3 2.3.3 Pathogenesis of Corneal
1.5 Clinical Findings ............ 5 Parasitic Ulceration ......... 22
1.6 Pathophysiology and 2.4 Basics of Amniotic
Genetics ................... 6 Membrane Transplantation 23
1.7 Differential Diagnosis ....... 7 2.4.1 Anti-inflammatory Effects ... 23
1.8 Management .............. 8 2.4.2 Anti-angiogenic Effects ..... 24
1.8.1 Medical .................... 8 2.4.3 Promoting
1.8.2 Surgical .................... 8 Re-epithelialization ......... 25
1.9 Future Directions ........... 11 2.4.4 Anti-microbial Effects ....... 26
1.10 Summary .................. 11 2.5 Clinical Application of
Amniotic Membrane
Chapter 2 Transplantation ............ 26
Amniotic Membrane Transplantation 2.5.1 Technique of Amniotic
for the Treatment of Corneal Membrane Transplantation 26
Ulceration in Infectious Keratitis 2.5.1.1 Human Amniotic Membrane
Preparation ................ 26
Arnd Heiligenhaus, Carsten Heinz,
2.5.1.2 Surgery .................... 27
Klaus Schmitz, Christoph Tappeiner,
2.5.1.3 Onlay Technique ........... 27
Dirk Bauer, Daniel Meller
2.5.1.4 Inlay Technique ............ 27
2.1 Introduction ............... 15 2.5.1.5 Multilayer Technique ....... 28
2.2 Clinical Aspects of Corneal 2.5.1.6 Postoperative Management 28
Ulceration in Infectious 2.5.2 Use of Amniotic Membrane
Keratitis ................... 15 Transplantation in Infectious
2.2.1 Herpetic Corneal Ulceration 15 Corneal Ulceration .......... 29
2.2.1.1 Clinical Features ............ 15 2.5.2.1 Herpetic Ulceration ......... 29
2.2.1.2 Treatment ................. 16 2.5.2.2 Neurotrophic Ulceration .... 30
2.2.2 Bacterial Corneal Ulceration 18 2.5.2.3 Bacterial Ulceration ......... 30
2.2.2.1 Clinical Features ............ 18 2.5.2.4 Acanthamoeba Ulceration .. 31
2.2.2.2 Treatment ................. 18 2.5.2.5 Keratoplasty and Amniotic
2.2.3 Parasitic Corneal Ulceration 20 Membrane Transplantation 31
 Contents
Chapter 3 3.3.2.3 Reconstruction of Corneal
Corneal Regenerative Medicine: Endothelium on Denuded
Corneal Substitutes Corneal Stromas ............ 45
for Transplantation 3.3.3 Corneal Replacements
with Noncorneal Cell
May Griffith, Per Fagerholm,
Sources .................... 45
Wenguang Liu,
3.4 Biomimetic Tissue-
Christopher R. McLaughlin, Fengfu Li
engineered Scaffolds
3.1 Introduction ............... 37 as Templates
3.1.1 Key Corneal Properties for Corneal Reconstruction
and the Need for Substitutes or Regeneration ............ 45
for Donor Tissues .......... 37 3.4.1 Tissue-engineered
3.2 Synthetic “Artificial Corneas” Substrates as Cell Delivery
or Keratoprostheses ........ 38 Systems ................... 45
3.2.1 Development 3.4.1.1 Substrates for Corneal
of Keratoprostheses ........ 38 Epithelial Cells ............. 46
3.2.2 Keratoprostheses Tested 3.4.1.2 Substrates for Corneal
Clinically or in Clinical Use ... 39 Stromal Cells .............. 46
3.2.2.1 Boston Keratoprosthesis .... 39 3.4.2 Acellular Scaffolds
3.2.2.2 Osteo-odonto as Bio-interactive Templates
Keratoprosthesis ........... 39 for Regeneration ........... 46
3.2.2.3 AlphaCor™ Keratoprosthesis 39 3.4.3 Corneal Substitutes
3.2.2.4 BioKPro III .................. 40 with Delivery of Drugs
3.2.2.5 Seoul Type Keratoprosthesis 41 or Bioactive Factors ......... 50
3.2.2.6 Pintucci Keratoprosthesis ... 41 3.5 Summary of Corneal
3.2.3 Recent Developments Substitute Development
in Keratoprosthesis Research 41 and Future Clinical Use ..... 51
3.2.3.1 Modification
of Keratoprosthesis Chapter 4
Biomaterials Phototherapeutic Keratectomy
with Bioactive Factors ...... 42 in Corneal Dystrophies
3.2.3 Stanford Keratoprosthesis ... 42
Berthold Seitz and Achim Langenbucher
3.2.3.3 Collagen-based
Keratoprosthesis ........... 43 4.1 Introduction ............... 55
3.3 Naturally Fabricated Corneal 4.2 Nonmechanical Corneal
Replacements .............. 44 Surgery – Definition ........ 55
3.3.1 Self-assembled Corneal 4.2.1 Curative ................... 56
Equivalents ................ 44 4.2.1.1 Corneal Transplantation ..... 56
3.3.2 Corneal Layers 4.2.1.2 Phototherapeutic
Reconstructed Keratectomy ............... 56
on Pre-existing Natural 4.2.2 Refractive .................. 56
Scaffolds ................... 44 4.3 Patient Counseling ......... 56
3.3.2.1 Corneal Epithelial 4.3.1 Corneal Clarity ............. 57
Reconstruction 4.3.2 Visual Acuity and Refraction 57
on Amniotic Membranes .... 44 4.3.3 Recurrent Corneal Erosion
3.3.2.2 Reconstruction Syndrome ................. 58
of Corneal Epithelial 4.4 Diagnostic Approaches
and Stromal Layers to Surgical Decision-making 58
on Amniotic Membranes .... 44 4.4.1 Patient Selection ........... 59
Contents I
4.4.2 Refractometry .............. 59 4.7.4 Endothelium ............... 72
4.4.3 Biomicroscopy 4.7.5 Recurrences of Dystrophies
at the Slit-lamp ............. 59 on Grafts after Keratoplasty 73
4.4.3.1 Pattern Assessment ......... 59 4.8 Complications ............. 74
4.4.3.2 Horizontal Extension ....... 59 4.8.1 Delayed Epithelial Healing .. 74
4.4.3.3 Sagittal Extension .......... 60 4.8.2 Refractive and Topographic
4.4.4 Enhanced Examinations .... 61 Changes ................... 75
4.4.4.1 Keratometry ............... 61 4.8.2.1 “Hyperopic Shift” ........... 75
4.4.4.2 Topography Analysis ........ 61 4.8.2.2 Paradoxical Myopic Shift .... 77
4.4.4.3 Assessment of Corneal 4.8.2.3 Irregular Astigmatism
Thickness Profile ........... 61 (Focal Ablation) ............ 77
4.5 Strategic 4.8.3 “Haze”/Scars ............... 77
Planning and Surgical 4.8.4 Infectious Ulcer/Melting/
Techniques ................ 62 Perforation ................ 77
4.5.1 General Concepts .......... 62 4.8.5 Immunologic Allograft
4.5.2 Removal of Opacities ....... 63 Rejection after PKP ......... 78
4.5.3 Smoothing of the Surface 4.8.6 Recurrence of Disease ...... 78
and Reducing Irregular 4.8.7 Corneal Ectasia ............. 78
Astigmatism ............... 64 4.8.8 Intraocular Lens Power
4.5.3.1 Repeated Application Calculation for Cataract
of “Masking Fluids” ......... 64 Surgery after PTK ........... 78
4.5.3.2 Simultaneous Refractive 4.9 Contraindications .......... 79
Ablation ................... 65 4.10 Closing Remarks ........... 80
4.5.4 Improvement in Epithelial
Adhesion .................. 66 Chapter 5
4.5.5 Laser Parameters . . . . . . . . . . . 66 Classification of Corneal Dystrophies
4.5.6 Combination on a Molecular Genetic Basis
with Mitomycin-C .......... 67
Francis L. Munier, Daniel F. Schorderet
4.6 Medical Treatment ......... 67
4.6.1 Preoperative ............... 67 5.1 Introduction ............... 83
4.6.2 Intraoperative .............. 67 5.2 Anterior Corneal
4.6.3 Postoperative .............. 68 Dystrophies (Epithelial, Basal
4.7 Indications and Outcome ... 68 Membrane, Bowman’s Layer,
4.7.1 Criteria of Outcome ......... 68 Anterior Stroma) ........... 83
4.7.1.1 Morphology ............... 68 5.2.1 Meesmann Corneal
4.7.1.2 Function ................... 68 Dystrophy (MIM 122100)
4.7.1.3 Recurrent Erosions ......... 69 Including Stocker-Holt ...... 83
4.7.2 Corneal Epithelium 5.2.2 Lisch Corneal Dystrophy .... 85
and/or Basement Membrane 70 5.2.3 Epithelial Basement
4.7.2.1 Meesmann-Wilke Dystrophy 70 Membrane Dystrophy
4.7.2.2 Epithelial Basement (MIM 121820) ............. 85
Membrane Dystrophy ...... 70 5.2.4 Gelatinous Drop-like
4.7.2.3 Granular Dystrophy ......... 70 Dystrophy (MIM 204870) .... 86
4.7.2.4 Lattice Dystrophy .......... 70 5.2.5 Thiel-Behnke Corneal
4.7.3 Stroma .................... 72 Dystrophy Type I (MIM
4.7.3.1 Bowman’s Layer Dystrophies 72 602082) ................... 87
4.7.3.2 Crystalline Dystrophy 5.2.6 Reis-Bücklers’ Corneal
(Schnyder) ................. 72 Dystrophy (MIM 608470) .... 88
4.7.3.3 Macular Dystrophy ......... 72 5.3 Stromal Corneal Dystrophies 88