Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaPurpose: To evaluate the corneal and anterior chamber condition inpatients with bullous keratopathy who underwent penetratingkeratoplaty (PK).Methods: A retrospective review of clinical records of allconsecutive patients with bullous keratopathy, referred for PK for theperiod January 2005 - December 2010, was performed. Preoperativestatus was analyzed with an emphasis on corneal condition andanterior segment abnormalities- presence and extent of cornealneovascularization, ocilar surface disorders, iris injuries withdistorted pupil, anterior synechia and subluxated intraocular lens.Results: Bullous keratophaty was present in 54 of all 141 patientswho underwent PK. Forty one of the patients had pseudophakickeratopathy, 6 pts were with aphakic and 3 with phakic keratopathy.One patient had graft failure, 1 pts- posttraumatic endothelialdecompensation and in 2 of them Fuchs endothelial decompensationwas found. Ocular surface abnormalities were diagnosed in 51 of thepatients (94%) . In 30 of the cases (56%) deep and superficial cornealneovasclarization was observed. Other pathological findingsincluded: painful epithelial bullae in 39cases (72%), subepithelial andstromal fibrosis in 18 patients (33%). In most patients all pathologicalsings were present but with different severity. Cornea was notneovascularizated and there was no fibrosis in only 5 cases. Theocular surface was not compromised in 3 of the patients. Anothermarker of advanced pathology was visual acuity: BCVA between0,05 and 0,1 in 1 patient (2%), light perception to 0,05 in 26 pts(47%) and hand movement to light perceptiont in the rest of the pts.Conclusions: The analysis of patients with bullous keratopathydemonstrated that advanced disease and severely affected corneal andanterior segment anatomy were present in all of the cases but withdifferent severity. In all patients from our studied group thepathological changes excluded the option for lamellar graftingtechniques, and PK remained the only treatment possibility. Mainreasons for the accumulation of such a pool of challenging patientswith delayed treatment are unreasonably prolonged conservativetherapy of postoperative complications and lack of donor tissue.Addressing these issues could allow the use of lamellar graftingtechniques, applicable only in the initial stages of bullouskeratophaty. At present PK remains the main therapeutic option forour patient pool.Commercial Relationships: Elena Adjievska, None; Petja I.Vassileva, None; Nikolay Surchev, None; Tatyana Hergeldzhieva-Fileva, NoneProgram Number: 2572 Poster Board Number: D0372Presentation Time: 2:45 PM - 4:30 PMHO-2 knockdown delays wound healing in Human CornealEpithelial (HCE) cells by altering the signaling of EGFR andFAK mediated pathwayAdna Halilovic, Daohong Lin, Gregory Joseph, Brian Shkolnik,Michal L. Schwartzman. Pharmacology, New York Medical College,Valhalla, NY.Purpose: Heme oxygenase (HO) represents an intrinsiccytoprotective and anti-inflammatory system. Inhibition of HOactivity significantly impairs wound healing in human cornealepithelial (HCE) cells. We have shown that HO-2 knockdown in vitroattenuates corneal wound healing and that HO-2 null mice display anaberrant corneal wound healing following injury. In this study, weinvestigated the mechanisms that may contribute to HO-2cytoprotective role in the corneal epithelium.Methods: HCE cells were stably transfected with lentivirus HO-2shRNA or non-target shRNA plasmids. Modified Boyden Chamberassay was used to study the migration of HO-2 knockdown cells.Flow cytometry cell cycle analysis was done using propidium iodidestaining. Western blot was performed to evaluate the expression ofproteins involved in migration and proliferation in HO-2 shRNA andnon-target shRNA cells.Results: HO-2 knockdown, using virus-mediated shRNA, impairedHCE wound healing by 35% and 25% at 24h and 48h after injury,respectively. Furthermore, HO-2 knockdown inhibited basal andEGF(10ng/mL)-stimulated HCE migration by 50% and 40%,respectively and was associated with a 35% decrease in p-Akt and45% decrease in p-EGFR levels. Flow cytometric analysis showedthat EGF-stimulated cell cycle progression was attenuated in HO-2knockdown cells. Immunofluorescence of HO-2shRNA and controltransfected cells revealed a cytoplasmic distribution of p-FAK. Uponinjury, control cells displayed typical p-FAK as focal adhesion pointsin the membrane, whereas in HO-2 knockdown cells p-FAK had nofocal distribution.Conclusions: Knockdown of HO-2 results in attenuated cornealepithelial wound healing. Deficiency of HO-2 impairs wound healingby a mechanism that involves alterations in ERK, Akt and FAKsignaling pathways, all of which have been shown to play animportant role in growth factor-mediated cell migration andproliferation following injury.Commercial Relationships: Adna Halilovic, None; Daohong Lin,None; Gregory Joseph, None; Brian Shkolnik, None; Michal L.Schwartzman, NoneSupport: NIH Grant EY06513 (MLS)Program Number: 2573 Poster Board Number: D0373Presentation Time: 2:45 PM - 4:30 PMDecreased Incidence of Perioperative Corneal Injuries Followingan Ophthalmology Educational Initiative For AnesthesiaProviders at an Academic Medical CenterAmanda L. Ely, Ingrid U. Scott, Tabassum F. Ali, Denise Kerchner,David Liang, Michael Wilkinson. Ophthalmology, Penn StateHershey Ophthalmology, Hershey, PA.Purpose: To investigate whether an ophthalmology educationalinitiative directed toward anesthesia providers can decrease theincidence of perioperative corneal injury at an academic medicalcenter.Methods: Prospective chart review of consults placed forperioperative eye pain resulting from corneal injury between July 1,2011 and January 4, 2012 (including patient and surgical risk factorsfor corneal injury as reported in the literature). An ophthalmologyeducational initiative, including a Grand Rounds lecture anddistribution of educational materials regarding perioperative ocularcare, was provided to anesthesia providers on January 5, 2012 basedon the Mayo Clinic Model (Martin et al., Anesthesiology 2009).Beginning on January 5, 2012, an email was sent to the attending andresident physician of any patient who experienced a perioperativecorneal injury; the email notified the physicians of the corneal injuryand provided information to the physicians on how such injuries maybe prevented in the future. Prospective chart review of consults(identical to the pre-initiative data collection) was then performedbetween January 6, 2012 through June 30, 2012. The rates ofperioperative corneal injury pre- versus post-initiative werecompared.Results: The rate of perioperative corneal injury was 0.35% beforethe educational initiative compared with 0.18% following theinitiative (p=0.04). The proportions of corneal injuries that wereassociated with risk factors reported in the literature for such injurieswere not significantly different pre- versus post-initiative except forlength of surgical case. Pre-initiative a higher proportion of cornealinjuries occurred after a surgery