Cornea - ARVO

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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaHispanic ethnicity (16/45 vs 0/6) was associated with higherrecurrence rates. Younger age (37.8 vs 45.1, p= 0.0630) was alsoassociated with recurrence. Use of sutures was not found to correlatewith recurrence rate (4/15 vs 12/36, p= 0.7485). Size of thepterygium was not associated with higher recurrence rate. Variationsin the dose, frequency, and duration of steroid use did not differbetween recurrence and non-recurrence groups.Conclusions: Resident recurrence rates and complications werecomparable to other reports within the literature. The two major riskfactors associated with recurrence within this study were Hispanicethnicity and younger age. Differences in the vigor of theinflammatory response within these groups may underlie thedifference in risk. However, the post-operative management withanti-inflammatory medication, including initial frequency, week offirst taper, and total duration, was not found to be significantlydifferent between these two groups. Additionally, the use ofabsorbable sutures, which might enhance the inflammatory response,did not affect the risk of recurrence. Intraoperative use of MMC forinitial excisions was rare in this academic setting, but has been usedfor many excisions of recurrent pterygium. Further investigation ofMMC for initial excisions in these high-risk groups may bewarranted.Commercial Relationships: Adam Sise, None; Tanuj Banker,None; Wellington Chang, None; Sasikala Pillai, NoneProgram Number: 3105 Poster Board Number: D0040Presentation Time: 8:30 AM - 10:15 AMComparison of fibrin glue and autologous blood for conjunctivalautograft fixation in pterygium surgerySalina Teja, Sophie Boucher, Kashif Baig. Ophthalmology,University of Ottawa Eye Institute, Ottawa, ON, Canada.Purpose: Our purpose is to investigate the use of a novel technique,graft fixation with autologous blood, by comparing its anatomic andvisual outcomes to those obtained with fibrin glue in pterygiumexcision surgery.Methods: This is a retrospective comparative case series of patientswith a primary nasal pterygium who underwent excision. All patientshad a conjunctival autograft from the superior bulbar conjunctiva tocover the scleral bed. 17 patients had fixation of the autograft withautologous blood (AB) and 17 patients had fixation with fibrin glue(FG). Data was collected up to 6-months post operatively andincluded; surgical cost and time, conjunctival graft stability andhealing, visual acuity and pterygium recurrence. Outcomes werecompared between the two groups and assessed for statisticalsignificance with a paired student t test.Results: Of our 34 patients, 15 were female and 18 were male with amean age of 52. The mean size of conjunctival autograft was 36mm2in the AB group and 42mm2 in the FG group. There were no intraoperativecomplications in either group. Surgical costs differed ineach group: the FG group incurred the cost of the fibrin glue whereasthe AB group had the additional costs associated with an extra 15minutes of procedure time. At 1-month post-operatively, 4 patients inthe AB group had lost their graft compared to zero in the FG group,showing greater stability in the FG group. Mild graft displacementwas seen in 3 patients in each group. The visual acuity was stable inboth groups. There was no incidence of pterygium recurrence ineither group. 6-month follow up outcomes will be analyzed byFebruary 2013.Conclusions: Pterygium recurrence rates vary due to many factorsincluding surgical technique. The conjunctival autograft fixated withautologous blood has been shown to be safe and effective but its roleis not well established. The fibrin glue technique is widely used butposes a risk of hypersensitivity reactions, discomfort, scarring andinfection. Our preliminary results show that fixation with autologousblood produces similar visual and pterygium recurrence outcomes tofibrin glue fixation, however seems to have less stable grafts atfollow up. Our comparison of the efficacy and stability of theconjunctival autograft between the two techniques at 6 month followup will help to further establish the role of autologous blood inpterygium surgery.Commercial Relationships: Salina Teja, None; Sophie Boucher,None; Kashif Baig, Bausch and Lomb (F), Allergan (C), Alcon (C)Support: University of Ottawa Medical Research FundProgram Number: 3106 Poster Board Number: D0041Presentation Time: 8:30 AM - 10:15 AMExpression of the pro-inflammatory molecule RAGE in humanpterygiaElia J. Duh 1 , Samar A. Al-Swailem 2 , Zhenhua Xu 1 , Samuel C. Yiu 1, 2 ,Lijuan Wu 1 . 1 Ophthalmology, Johns Hopkins Wilmer Eye Inst,Baltimore, MD; 2 King Khaled Eye Specialist Hospital, Riyadh, SaudiArabia.Purpose: Inflammation is associated with development and growthof pterygia, including promotion of angiogenesis. The importantinflammatory mediators in pterygia are continuing to be defined.RAGE, the Receptor for Advanced Glycation Endproducts, is knownto be a strong pro-inflammatory molecule expressed in vascularendothelium and other cell types. In this study, we examined RAGEexpression and immunolocalization in human pterygium and normalconjunctival tissue.Methods: Pterygium specimens were obtained during surgery at theKing Khaled Eye Specialist Hospital (KKESH). In the same patients,conjunctiva were obtained from the autograft during surgery. Tissuespecimens were formalin-fixed and paraffin-embedded. Tissuesections were analyzed by immunohistochemistry with anti-RAGEantibody. Expression and localization of RAGE were evaluated inpterygium and corresponding conjunctiva.Results: In both pterygium tissue and corresponding conjunctiva,there was expression of RAGE in the epithelium. In addition, othercell types exhibited expression, notably vascular endothelial cells aswell as fibroblasts and possibly macrophages. There was distention ofendothelial cells in pterygium specimens with associated prominentstaining of RAGE in pterygium specimens as compared to normalconjunctiva.Conclusions: Our data indicate the expression of RAGE in bothpterygial tissues and conjunctiva. The prominent expression ofRAGE in vascular endothelium in pterygia suggest a possible role ofthis molecule in promoting the inflammatory process in pterygiumprogression.Commercial Relationships: Elia J. Duh, None; Samar A. Al-Swailem, None; Zhenhua Xu, None; Samuel C. Yiu, None; LijuanWu, NoneSupport: This work was supported by funds from Research toPrevent Blindness and a KKESH/JHU-WEI grant.Program Number: 3107 Poster Board Number: D0042Presentation Time: 8:30 AM - 10:15 AMEffect of Porcine Chondrocyte Derived Extracellular Matrix onthe Pterygium in Mouse ModelKyeong Hwan Kim 1, 2 , Hye Sook Lee 2 , Jae Wook Yang 1, 2 .1 Department of Ophthalmology, Inje University College of Medicine,Busan, Republic of Korea; 2 Ocular Neovascular Research Center,Inje University Busan Paik Hospital, Busan, Republic of Korea.Purpose: To investigate the effect of porcine chondrocyte derivedextracellular matrix (PCDECM) on the pterygial tissue growth inmouse model.©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaMethods: Human pterygial epithelial cells were isolated and culturedfrom the specimens during the surgical removal (IRB No. : 12128).Cultured cells were stained with pan-CK, CK3/2p, vimentin, mucin-1, and CK13 for the confirmation of pterygial epithelial cells.PCDECM were supplied from the another laboratory (RegenprimeCo. Ltd., Gyeonggi-do, South Korea), which was manufactured withthe method described elsewhere. To establish pterygium murinemodel, 10,000 cells in 10 microliters of PBS were injected to thenasal subconjunctival space in both eyes of athymic nude mice.PCDECM dissolved in PBS (25 mg/mL, 10 microliters) were injectedto the nasal subconjunctival space in the right eye 7, 10 and 14 daysafter epithelial cell injection (ECM group), and PBS (10 microliters)were injected to the same area of the opposite eye as same scheduleas the left eye (control group). Image analysis with the photographwas performed using ImageJ® to compare the lesion size.Results: Isolated pterygial cells were positive for pan-CK, CK3/2p,vimentin and mucin-1, and negative for CK13 underimmunofluorescence microscopy. Pterygial lesion in mouse modelwas confirmed 7 days after subconjunctival injection of humalpterygial epithelial cells. There was no significant difference in lesionsize baseline (7 days after epithelial cell injection; 25.6% in ECMgroup vs. 24.9% in control group, expressed as the ratio of lesion areato entire cornea). On the day 17 after epithelial cell injection, thelesion size compared to the entire cornea was increased to 35.4% incontrol group, however, ECM group showed less change in size as26.4% (9.8 % point and 0.8 % point increase from the baseline,respectively).Conclusions: Our findings suggest that PCDECM seems to suppresspterygial epithelial cell growth and it could be used as a promisingmaterial for the noninvasive treatment of pterygium.Commercial Relationships: Kyeong Hwan Kim, None; Hye SookLee, None; Jae Wook Yang, NoneSupport: Grant of the Korea Healthcare Technology R&D Project,Ministry of Health & Welfare Affairs, Republic of Korea. (grantnumber A120006 and A120078)Program Number: 3108 Poster Board Number: D0043Presentation Time: 8:30 AM - 10:15 AMLinear systems analysis of Pre and Post Operative ZernikeCoefficients in LASIK SurgeryDaniel R. Neal 1 , Thomas D. Raymond 1 , Amelia Saliba 2 , Jill V.Treyes 2 . 1 Research and Development, AMO WaveFront Sciences,LLC, Albuquerque, NM; 2 Research and Development, AMODevelopment Inc, Milpitas, CA.Purpose: Improvements in LASIK outcomes will require advancedanalyses to reveal correlations between preoperative measurementsand systematic variations in outcomes. We postulate that pairwiseand multivariate analyses could be used effectively to identifycorrectable systematic errors in LASIK outcomes.Methods: This retrospective study analyzed the pre and postoperative aberrometry and keratometry data on 120 eyes of 63patients that underwent normal LASIK surgery using a 193 nmexcimer laser equipped with iris registration. Pre- and post-surgerymeasurements were taken with a combined aberrometer and cornealtopographer instrument. Wavefront measurements were expressed inZernike polynomials and resized to 4 mm analysis pupil. JMP 8.0software was used to analyze the third to fourth order Zernikecoefficients for both pairwise and multivariate correlation andstatistical significance.Results: Statistically significant correlations were observed betweenpre operative and post operative wavefront coefficients. Figure 1illustrates the pre to post operative multivariate correlations for theOD eyes; statistical significance for pairwise correlations are denotedwith asterisks. Note that the correlation coefficients can exceed 40%.Both low and high order terms interact to affect the outcome. Thesedata support the hypothesis that systematic errors in LASIKoutcomes can be identified through these analyses.Conclusions: That many of the correlations are statisticallysignificant affords the hope that improvements in treatment planningcan eliminate many of these errors thereby enhancing the quality ofLASIK outcomes.Figure 1 The multivariate correlation between pre and post operativeZernike coefficients for wavefront aberration are shown above;asterisks denote correlations that are statistically significant. Thesedata show the well known correlation between pre operative sphericalequivalent (Z4) and post operative spherical aberration (Z12) as wellas many other correlated terms.Commercial Relationships: Daniel R. Neal, Abbott Medical Optics(E), Abbott Medical Optics/US20120172854A1 (P); Thomas D.Raymond, Abbott Medical Optics (E), Thomas D. Raymond (S);Amelia Saliba, AMO (E), Abbott (I); Jill V. Treyes, AMODevelopment (E)Support: Internally funded by AMOClinical Trial: NCT01220466Program Number: 3109 Poster Board Number: D0044Presentation Time: 8:30 AM - 10:15 AMA novel model of digitized clinical validation of femtosecondLASIK flap diameter and opaque bubble layer (OBL) incidenceIoanna Kontari 1 , George Asimellis 1 , A. John Kanellopoulos 1, 2 .1 LaserVision.gr Eye Institute, Athens, Greece; 2 NYU MedicalSchool, New York, NY.Purpose: The development of digital, quantitative and accurateanalysis of LASIK flap diameter and OBL occurrence.Methods: Flaps from 100 consecutive myopic and hyperopic LASIKpatients, treated with the Alcon-WaveLight FS200 femtosecond andEX500 excimer lasers were digitally recorded and processed. Flapdimensions and OBL extent was evaluated utilizing a newlydevelopeddigital procedure with a commercially available imageprocessing software. Specifically, the flap creation report imageprovided by the FS200 internal system was analyzed digitally andcalibrated on a scale converting pixels to measurable length in mm.In a similar fashion, the OBL occurrence was measured as apercentage of the actual flap surface area.Results: For the myopic cases, with planned flap diameter 8.00 (n =20) and 8.50 mm (n = 60), a small negative bias was discovered (-0.15 mm and -0.12 mm, respectively) with very small size fluctuation(diameter stdev = ± 0.04 and ± 0.03 mm, respectively). For thehyperopic cases, with planned flap diameter 9.50 mm (n = 20), asmall positive bias was discovered (+ 0.06 mm), again with verysmall size variation (diameter stdev < 0.009 mm). Of the flaps©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.
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