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European Journal of Ophthalmology 2006To compare changes in corneal topographic parameters after cataract surgery in eyes with different severities of arcus lipoides. (Comparative Study)
Comparative Study
PURPOSE
To compare changes in corneal topographic parameters after cataract surgery in eyes with different severities of arcus lipoides.
METHODS
Fourty eyes of 40 patients (23 women, 17 men, age 71.3+/-20.4 years, range 40 to 89 years) were studied prospectively in a consecutive, non-interventional, comparative series of cases. Eyes were classed in three groups (0 to 2) according to the assessed grade of arcus lipoides (none, <180 degrees, >180 degrees). Corneal topography (Tomey TMS-2) was performed preoperatively and at 1 and 10 days and 1 and 3 months following cataract surgery (superior 4.0 mm clear corneal incision, no suture). Keratometric astigmatism (Dcyl), surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) were evaluated for the different groups and time-points, using the Kruskal-Wallis, Wilcoxon, and Mann-Whitney statistical tests.
RESULTS
No significant preoperative difference was found in mean Dcyl, SRI, or PVA; preoperative SAI was lower in Group 1. Postoperatively Dcyl was increased at day 1 in Groups 1 and 2, and remained higher in Group 2 until month 1. At month 3 significant differences among Groups 0, 1, and 2 disappeared.
CONCLUSIONS
The 4.0 mm superior clear corneal incision is a safe method for cataract surgery in the presence of arcus lipoides. This procedure induces greater corneal astigmatism, surface irregularity, and lower PVA in the early postoperative period in cases with arcus lipoides than in normal corneas. Concerning final results, wound healing was not affected by greater severity of arcus lipoides, although stabilization of the corneal surface tended to be slower.
Topics: Adult; Aged; Aged, 80 and over; Arcus Senilis; Astigmatism; Cornea; Corneal Topography; Female; Humans; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Prospective Studies; Visual Acuity; Wound Healing
PubMed: 16496241
DOI: 10.1177/112067210601600105 -
Klinische Monatsblatter Fur... Sep 2004Arcus lipoides corneae is a common bilateral degenerative disorder with ageing but only rarely occurs unilaterally. Clinically visible cream-coloured ring-shaped corneal...
BACKGROUND
Arcus lipoides corneae is a common bilateral degenerative disorder with ageing but only rarely occurs unilaterally. Clinically visible cream-coloured ring-shaped corneal opacities are caused by excessive lipoid deposits in the corneal stroma. Our aim is to discuss theoretical aspects of the possible impact and pathomechanism of unilateral ptosis in unilateral arcus lipoides.
CASE REPORT
The authors report the case of a 70-year-old female patient who was treated for chronic pancreatitis and hyperlipoproteinemia. She had congenital ptosis on the left side, and an arcus lipoides corneae in her left eye. The patient underwent extracapsular cataract extraction, and irregular high-grade astigmatism developed. An irregularity of the wound healing was apparent from the keratometric values, which decreased after removal of the corneal sutures.
CONCLUSION
The known etiological factors of unilateral arcus lipoides, like contralateral stenosis of the internal carotid artery, traumatic or iatrogenic hypotony, chronic iridocyclitis of the eye were absent in our patient.
Topics: Aged; Arcus Senilis; Astigmatism; Blepharoptosis; Cholesterol; Chronic Disease; Corneal Topography; Female; Humans; Hypercholesterolemia; Lipase; Pancreatitis; Postoperative Complications; Risk Factors; Triglycerides
PubMed: 15459848
DOI: 10.1055/s-2004-813565 -
The American Journal of Medicine Sep 2004To assess the accuracy of bedside findings for diagnosing coronary artery disease and acute myocardial infarction. (Review)
Review
PURPOSE
To assess the accuracy of bedside findings for diagnosing coronary artery disease and acute myocardial infarction.
METHODS
A MEDLINE search was performed to retrieve articles published from January 1966 to January 2003 that were relevant to the bedside diagnosis of coronary disease in adults.
RESULTS
In patients with stable, intermittent chest pain, the most useful bedside predictors for a diagnosis of coronary disease were found to be the presence of typical angina (likelihood ratio [LR]=5.8; 95% confidence interval [CI]: 4.2 to 7.8), serum cholesterol level >300 mg/dL (LR=4.0; 95% CI: 2.5 to 6.3), history of prior myocardial infarction (LR=3.8; 95% CI: 2.1 to 6.8), and age >70 years (LR=2.6; 95% CI: 1.8 to 4.0). Nonanginal chest pain (LR=0.1; 95% CI: 0.1 to 0.2), pain duration >30 minutes (LR=0.1; 95% CI: 0.0 to 0.9), and intermittent dysphagia (LR=0.2; 95% CI: 0.1 to 0.8) argued against a diagnosis of coronary disease. In patients with acute chest pain, the most important bedside predictors for a diagnosis of myocardial infarction were new ST elevation (LR=22; 95% CI: 16 to 30), new Q waves (LR=22; 95% CI: 7.6 to 62), and new ST depression (LR=4.5; 95% CI: 3.6 to 5.6). A normal electrocardiogram (LR=0.2; 95% CI: 0.1 to 0.3), chest wall tenderness (LR=0.3; 95% CI: 0.2 to 0.4), and pain that was pleuritic (LR=0.2; 95% CI: 0.2 to 0.3), sharp (LR=0.3; 95% CI: 0.2 to 0.5), or positional (LR=0.3; 95% CI: 0.2 to 0.5) argued against the diagnosis of myocardial infarction.
CONCLUSION
The accuracy of bedside predictors depends on the clinical setting. In the evaluation of stable, intermittent chest pain, a patient's description of pain was found to be the most important predictor of underlying coronary disease. In the evaluation of acute chest pain, the electrocardiogram was the most useful bedside predictor for a diagnosis of myocardial infarction. Aside from the extremes in cholesterol values, the analysis of traditional risk factors changed the probability of coronary disease or myocardial infarction very little or not at all.
Topics: Acute Disease; Adult; Aged; Angina Pectoris; Arcus Senilis; Coronary Artery Disease; Deglutition Disorders; Diagnosis, Differential; Electrocardiography; Female; Humans; Hypercholesterolemia; Likelihood Functions; Male; Medical History Taking; Middle Aged; Physical Examination; Point-of-Care Systems; Predictive Value of Tests; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Time Factors
PubMed: 15336583
DOI: 10.1016/j.amjmed.2004.03.021 -
Cardiovascular Journal of South Africa... 2004To determine whether an association exists between plasma lipoprotein constituents and the prevalence of corneal arcus in dyslipidaemic patients.
AIM
To determine whether an association exists between plasma lipoprotein constituents and the prevalence of corneal arcus in dyslipidaemic patients.
METHODS
Adult patients (n = 115) were included if their fasting total serum cholesterol concentrations exceeded the 95th percentile or their serum low-density lipoprotein (LDL) : high density lipoprotein (HDL) ratios exceeded 5. Slit-lamp assessment of the corneas was performed.
RESULTS
The study group divided into a subgroup with arcus 37% (43) and a subgroup without arcus 63% (72). Total serum cholesterol and triglyceride levels were not associated with corneal arcus. A significant difference was found (p < 0.05) between the mean levels of LDL cholesterol (LDL-C) in the group without arcus (5.61 +/- 1.74 mmol/l) and the group with arcus (5.96 +/- 1.71 mmol/l). The mean serum HDL-cholesterol (HDL-C) in the group with corneal arcus was 1.04 +/- 0.30 mmol/l as opposed to 1.31 +/- 0.38 mmol/l in the group without arcus (p < 0.005 for difference). The mean LDL-C : HDL-C ratio in the group without arcus was 4.28 (SD: 1.99), and 5.73 (SD: 2.09) in the group with a corneal arcus (p < 0.05).
CONCLUSIONS
Low HDL-C levels, high LDL-C levels and LDL-C : HDL-C ratios > 5 have been implicated as risk factors of numerous circulatory diseases. The observations in this study suggest that the presence of corneal arcus in the dyslipidaemic patient correlates strongly with these same risk indicators.
Topics: Adult; Arcus Senilis; Cohort Studies; Female; Humans; Hyperlipidemias; Lipoproteins; Male; Middle Aged; Prevalence
PubMed: 15322572
DOI: No ID Found -
Clinical & Experimental Ophthalmology Aug 2004Pseudogerontoxon is a lesion that resembles a small segment of arcus senilis or gerontoxon and is seen in many individuals with limbal vernal or atopic...
Pseudogerontoxon is a lesion that resembles a small segment of arcus senilis or gerontoxon and is seen in many individuals with limbal vernal or atopic keratoconjunctivitis. It is an important clinical finding because pseudogerontoxon is often times the only clinical evidence of previous allergic eye disease. To the authors' knowledge, pseudogerontoxon has only rarely been mentioned, and has never been pictured, in the peer-reviewed literature. Three examples are presented of this important clinical entity.
Topics: Adult; Arcus Senilis; Conjunctivitis, Allergic; Female; Humans; Limbus Corneae; Male
PubMed: 15281982
DOI: 10.1111/j.1442-9071.2004.00849.x -
Eye (London, England) Oct 2004
Topics: Aged; Arcus Senilis; Disease Progression; Follow-Up Studies; Humans; Male
PubMed: 15060559
DOI: 10.1038/sj.eye.6701393 -
Journal of Cataract and Refractive... Jan 2004We report sporadic, bilateral keratoglobus associated with posterior subcapsular cataract in a 43-year-old man. Slitlamp biomicroscopy showed symmetric arcus...
We report sporadic, bilateral keratoglobus associated with posterior subcapsular cataract in a 43-year-old man. Slitlamp biomicroscopy showed symmetric arcus senilis-like deposits, a polygonal appearance resembling crocodile shagreen, an unusual endothelial appearance, and posterior subcapsular cataract. Orbscan II pachymetry maps (Bausch & Lomb) demonstrated bilateral diffuse corneal thinning (359.53 microm +/- 21.15 [SD] in the right eye and 379.61 +/- 11.49 microm in the left eye). These thickness values were confirmed by ultrasound pachymetry. In vivo confocal microscopy showed multiple criss-crossing dark lines and no identifiable cellular elements within the stroma. There were mild to moderate, guttata-like endothelial changes surrounded by pleomorphic cells. Phacoemulsification was performed in the left eye after careful consideration of the presenting features and modification of the surgical technique. Minimal structural alteration was observed during microstructural analysis 7 months after surgery. The endothelial morphology postoperatively was similar to that at baseline.
Topics: Adult; Cataract; Cell Count; Corneal Dystrophies, Hereditary; Corneal Topography; Endothelium, Corneal; Humans; Lens Capsule, Crystalline; Lens Implantation, Intraocular; Male; Microscopy, Confocal; Phacoemulsification
PubMed: 14967295
DOI: 10.1016/S0886-3350(03)00644-8 -
American Journal of Ophthalmology Feb 2004To quantify the association between arcus and hyperlipidemia in an older population.
PURPOSE
To quantify the association between arcus and hyperlipidemia in an older population.
DESIGN
Cross-sectional population-based study.
METHODS
Arcus and serum lipids were measured in the Blue Mountains Eye Study (n = 3,654, aged >49 years). Arcus was graded as absent, partial (<180 degrees) or circumferential (> or =180 degrees). Associations between arcus and hyperlipidemia were assessed using logistic regression, adjusting for age and vascular risk factors.
RESULTS
Arcus was strongly associated with age (P <.0001). After age adjustment, arcus was associated with male sex (P <.01) and diabetes (P <.02) but not with hypertension or smoking. Corneal arcus was significantly associated with progressively higher levels of total cholesterol over 5 mmol/l. Adjusted odds increased from 1.6 for cholesterol 6.0 to 6.9 mmol/l to 4.6 for cholesterol >8.0 mmol/l, and was 1.9 for high triglyceride >3.0 mmol/l.
CONCLUSION
This population-based finding confirms that corneal arcus was associated with hypercholesterolemia and hypertriglyceridemia in older persons.
Topics: Age Factors; Aged; Aged, 80 and over; Arcus Senilis; Cholesterol; Cross-Sectional Studies; Female; Humans; Hypercholesterolemia; Hypertriglyceridemia; Male; Middle Aged; Sex Factors; Triglycerides
PubMed: 14962437
DOI: 10.1016/S0002-9394(03)00902-4 -
Praxis Nov 2003A 35-year old man immigrated from Indonesia presented with "gout tophi" at his hands and lower extremities. Mother, aunt and uncle of this patient also suffered from... (Comparative Study)
Comparative Study
A 35-year old man immigrated from Indonesia presented with "gout tophi" at his hands and lower extremities. Mother, aunt and uncle of this patient also suffered from "gout tophi" as well as a heart disease not exactly known to the patient. Clinical investigation was suspicious for tendon xanthomas and revealed arcus lipoides corneae of both eyes. Total cholesterol was 10.5 mmol/l and HDL cholesterol was 0.8 mmol/l. Genetic investigation showed heterozygous familial hypercholesterolemia, i.e., heterozygous mutation of the gene encoding the LDL receptor protein. The patient was treated with atorvastatin 20 mg daily and a low cholesterol diet. Total cholesterol decreased to 6.5 mmol/l and HDL cholesterol increased to 1.5 mmol/l within 2-month treatment. We recommended the determination of serum lipids in further members of this family and genetic evaluation of the patient's children with regard to the mutation identified.
Topics: Adult; Arcus Senilis; Atorvastatin; Cholesterol; Cholesterol, HDL; Diagnosis, Differential; Female; Follow-Up Studies; Foot Dermatoses; Hand Dermatoses; Heart Diseases; Heptanoic Acids; Humans; Hyperlipoproteinemia Type II; Hypolipidemic Agents; Male; Middle Aged; Pyrroles; Time Factors; Xanthomatosis
PubMed: 14639818
DOI: 10.1024/0369-8394.92.45.1912 -
Klinische Monatsblatter Fur... Jul 2003Bilateral stromal corneal opacifications are important to detect potentially associated systemic diseases. Differential diagnosis includes, besides inflammatory diseases...
BACKGROUND
Bilateral stromal corneal opacifications are important to detect potentially associated systemic diseases. Differential diagnosis includes, besides inflammatory diseases mucopolysaccharidoses, HDL deficiencies (LCAT deficiency, Tangier disease and fish eye disease), Schnyder's crystalline corneal dystrophy, lipid keratopathy, cystinosis, gout and mucolipidoses.
CASE REPORT
The cornea of a 60-year old male patient, 180 cm height, showed milky hazy diffuse stromal inclusions with a prominent lipoid arc (VA O. D. 20/30 and O. S. 20/40, contre-jour VA less than 20/150). Ten years earlier, lattice corneal dystrophy was diagnosed. The cornea was thickened (0.61 mm). Except for the cornea, the anterior and posterior segments of the eye were unremarkable. Serum HDL concentration was decreased pathologically (7 mg/dl), although the LCAT activity was combined with apo-AI deficiency. Due to membrane instability, the erythrocytes showed target cell configuration. Penetrating excimer-laser keratoplasty was performed O. S. The epithelial wound closed only on the 32nd postoperative day. Histologically, the corneal stroma showed multiple vacuoles and amyloid deposits. Genetic analysis revealed two mutations in chromosome 16.
CONCLUSION
To our knowledge, this is the second description in the literature of a patient with LCAT deficiency and secondary amyloidosis of the cornea. Additionally, LCAT deficiency is associated with anaemia and proteinuria. After a penetrating keratoplasty, prolonged wound healing is possible. Because of the bilateral corneal clouding, the ophthalmologist may help to identify patients with LCAT deficiency. Thus, it is possible to start antiarteriosclerotic therapy.
Topics: Amyloidosis, Familial; Apolipoprotein A-I; Arcus Senilis; Chromosomes, Human, Pair 16; Corneal Dystrophies, Hereditary; Corneal Opacity; Corneal Stroma; DNA Mutational Analysis; Diagnosis, Differential; Humans; Keratoplasty, Penetrating; Laser Therapy; Lecithin Cholesterol Acyltransferase Deficiency; Male; Middle Aged; Ophthalmoscopy; Phosphatidylcholine-Sterol O-Acyltransferase
PubMed: 12886512
DOI: 10.1055/s-2003-40943