Purpose
To evaluate in two clinics vision improvement in AMD patients treated with a new corneal elastic modulus‐altering procedure (CPV) for light redirections onto multiple retinal areas.
Methods
...Ten eyes (6 wet, 4 dry), with best‐corrected near and distance visual acuities (CNVA and CDVA) between 20/80 and 20/400, without pathological retinal morphology completely affecting the central 10° (3 mm) on OCT, were given a single treatment of CPV and were examined for 12 months post‐CPV.
Results
LogMAR Mean CNVA and CDVA in treated eyes improved (p < 0.01) from pre‐CPV 0.957 and 0.942 to 0.512 and 0.638, 0.544 and 0.602, 0.531 and 0.672 at 1, 6 and 12 m, respectively. The number of ETDRS letters gained in mean binocular CNVA/CDVA were 22/15, 25/19, 25/18 at 1, 6, and 12 m, respectively. Administered NEI VFQ‐25 at 3 m improved from pre‐CPV. No CPV complications or adverse events occurred.
Conclusions
CPV effectively, safely, rapidly and comfortably redirects light onto functional retinal areas after a single treatment to provide, without visual training, significantly improved monocular and binocular near and distance vision without causing peripheral field restriction or diplopia in patients with atrophic or neovascular AMD with poor vision, including after anti‐VEGF therapy to which CPV is complementary and for which CPV may improve compliance because of improved vision restoration.
PURPUSE: To evaluate the quantity of vascular endothelial growth factor (VEGF) and its receptors (VEGFR) in the recipient cornea at the time of penetrating keratoplasty (PK). METHODS: Study included ...20 eyes scheduled for PK. Quantity of angiogenic growth factors and their receptors: VEGF, sVEGFR1 and sVEGFR3 were analysed using an enzyme‐linked immunosorbent assay. Postoperatively patients were followed‐up for 3 years. Frequency of corneal graft reaction and degree of corneal neovascularisation were recorded. Donor corneas obtained from cadaver eyes were controls (n=20). RESULTS: Overall quantity of VEGF‐A was 287.74 pg/ml (SD=129.181) in the inflammatory group, 115.37 pg/ml (SD=105.93) in non‐inflammatory group and 142.28 pg/ml (SD=93.081) in controls. sVEGFR1 and sVEGFR3 were significantly higher in non‐inflammatory as compared to inflammatory group. Eyes with graft reaction had significantly higher VEGF‐A (307.4 pg/ml, SD= 100.058) as compared to those without graft reaction (182.8 pg/ml, SD=124.987). Statistical analysis was done by t‐test. CONCLUSION: Graft reaction occurs more often in corneas with increased VEGF‐A. Elevated sVEGFR may act as a sink for VEGF and thus as suppressors of angiogenesis and graft reaction.
To evaluate the efficiency and safety of refractive lens exchange for the correction of high myopia.
We made a prospective study of the results of refractive lens exchange in 72 eyes that had ...undergone this surgical procedure between January 1996 and January 2001. Lens extraction by phacoemulsification was done by one surgeon on 34 patients. Follow-up was five months to five years (mean 48 months). The postoperative refractive target was emmetropia or a low degree of myopia. We compared pre- and postoperative uncorrected visual acuity, and preoperative best-corrected visual acuity with postoperative uncorrected visual acuity. Intra- and postoperative complications were recorded.
In 72.2% of the eyes best-corrected visual acuity (BCVA) was > or = 0.5 before surgery. Four years after refractive lens exchange, uncorrected visual acuity (UCVA) was > or = 0.5 in 58.3% of eyes, and the proportion of eyes with BCVA > or = 0.5 increased to 83.3%. The sphere was fully corrected in 70.8% of cases, remained within 1.0 D of emmetropia in 87.5% and within 2.0 D of emmetropia in 95.8%. Posterior capsule opacification developed in 22 eyes (30.5%) and was treated with neodymium:YAG (Nd:YAG) laser capsulotomy. Cystoid macular edema with retinal detachment occurred in one eye. No wound leakage or eye infections were observed during five years' follow-up.
Refractive lens exchange seems to be an effective alternative for the correction of high myopia, helping people over 40 years of age regain their distant vision.
To assess the usefulness of limbal-conjunctival autograft transplantation (LCAT) for the treatment of recurrent pterygium.
Seventeen eyes with advanced recurrent pterygium underwent LCAT All had ...already been treated at least twice either by simple excision (n=15) or by conjunctival rotation autograft (n=2). Three eyes (17.65%) had symblepharon at the time of surgery, so LCAT was combined with amniotic membrane transplantation. The autograft was taken from the supero-lateral part of the same eye and transferred to the area where the pterygium had been excised.
During 6-18 months of follow-up no postoperative complications occurred. In 15 eyes (88.24%) no pterygium recurrence was recorded; recurrence occurred in two eyes (11.76%) after 8 and 5 months. In three eyes with a combined symblepharon formation, remission of both pterygium and symblepharon growth was obtained.
LCAT seems to be a promising and safe procedure for recurrent pterygium.
Purpose We evaluated the effect of bevacizumab treatment in a prospective 2 year follow‐up study of 50 bdquohigh risk“ eyes undergoing penetrating keratoplasty (PKP).
Methods Hihg‐risk diseases were: ...2 Stevens Johnson syndrome (SJS), 6 chemical burns, 9 post‐herpetic, 16 other vascularized scars, 13 rejected grafts and 4 ulcers. PKP was performed in all 50 patients; combined with other procedures as follows: 12 “triple” procedures (PKP + cataract),11 PKP+ amniotic membrane transplantation (AMT),4 triple+AMT+ transplantation of limbal cells (LCAT). Subconjunctival injection of 25 mg/ml of bevacizumab was given to all patients at the end of surgery. Recipient corneal buttons were dissected into 3 corneal layers, stored in media for 24 hours at 37oC, and frozen till detection of VEGF quantity by immunoassay (ELISA). Corneal buttons from patients with non‐inflammatory diseases served as controls.
Results Decrease of corneal neovascularization was observed in 88% of patients who received bevacizumab, and 86% of grafts remained clear. Mean best corrected visual acuity had statistically significant increase in all groups from 0.03 to 0.5, with the poorest visual outcome in SJS patients. Average postoperative astigmatism was ‐4,83 Dcyl. Average endothelial cell loss was 22.83% after one, and 31.97% after two years (similar in all groups). Secreted VEGF was significantly higher in high risk cases (2436.7 pg/ml) as compared to non‐inflamed corneas (504.7 pg/ml).
Conclusion Combined “anti‐inflammatory“approach of AMT, LCAT and bevacizumab may significantly improve corneal graft survival rate in bdquohigh‐risk“ eyes.
Treatment: surgical methods DEKARIS, I; RATKOVIC, M; PAUK, M ...
Acta ophthalmologica (Oxford, England),
September 2012, 2012-09-00, 20120901, Volume:
90, Issue:
s249
Journal Article
Peer reviewed
Purpose Herpetic keratitis may lead to a significant corneal scaring and loss of vision which often leads to surgical treatment, which can be both penetrating (PKP) and deep anterior lamellar ...keratoplasty (DALK). However, the survival of corneal grafts is hampered by the presence of neovascularization (NV) and possible recurrence of herpetic disease. In our prospective study we have used bevacizumab treatment at the end of surgery, aiming to decrease corneal NV,and consequently to increase graft survival rate.
Methods Twelve high‐risk eyes undergoing PKP due to post‐herpetic corneal scar were progressively followed up for 17.54 months (range 6‐24). There were 7 females and 5 males of average age 51 and 44.28 years, respectively. All surgeries were ended by subconjunctival bevacizumab injection (25 mg/ml) under the NV. Grafts were prospectively examined for their clearance, presence of NV and endothelial cells density (ECD) loss.
Results At the end of follow‐up 11 out of 12 (91.7%) of corneal grafts remained clear; corneal NV reduction was found in all eyes and ECD loss at 24 months was 26.63%. Two out of 12 (16.6%) of patients had herpetic recurrence in their graft, which was successfully treated with systemic acyclovir.
Conclusion Subconjunctival bevacizumab may offer an adjunctive measure during surgical treatment of post‐herpetic corneal scars. This might be explained by suppression of the angiogenic potential mediated by VEGF in such patients.
Langerhans cells (LC) belong to the dendritic cell family and mediate Ag presentation in the cornea and ocular surface. Under normal physiological conditions, the central cornea is devoid of LC. ...Centripetal migration of LC plays a critical role in promoting immunoinflammatory responses in the eye including allograft rejection and herpetic keratitis. The molecular mechanisms responsible for ocular LC migration are poorly understood. To examine whether TNF-alpha mediates corneal LC migration and to establish the interaction of IL-1 and TNF-alpha in regulating LC migratory capacity, we utilized gene-targeted knockout mice lacking IL-1 receptor I (IL-1RI-/-), TNF receptor I (p55-/-), TNF receptor II (p75-/-), or both (p55-/-p75-/-). LC migration was induced by thermal cautery or cytokine injection and enumerated by an immunofluorescence assay. Migration of LC after cauterization and TNF-alpha injection was significantly depressed in both p55-/- and p75-/- mice. Similarly, in the first 72 h after intracorneal injection of IL-1alpha, LC migration was reduced in p55-/-, p75-/-, and p55-/-p75-/- mice. In contrast, injection of TNF-alpha in IL-1RI-/- mice led to normal migration of corneal LC indistinguishable from wild-type controls. These results suggest that the IL-1 induction of corneal LC migration is largely mediated by TNFR function, whereas TNF-alpha induction of LC migration is independent of IL-1RI activity. Moreover, the data suggest that both p55 and p75 signaling pathways are important in mediating LC migration in the cornea.
A 69 years old women underwent uneventful cataract surgery of her left eye with phacoemulsification and posterior chamber intraocular lens implantation in topical anesteshia. Patinet was ...postoperatively treated with combination of antibiotic and steroid in decreasing dosages during five weeks: one drop five times a day the first week, three times a day second to forth week and one time a day the fifth week. In each checkup, performed first postoperative day, 7 days, 5 weeks and 12 weeks after the operation, visual acuity with and without correction, tonometry, corneal transparency, biomicroscopy of posterior pole and measure of macular thickness by optical coherence tomography (OCT) were performed. At first day follow-up visit, the patient's visual acuity was 20/25 but 6 weeks after the operation, the patient's vision had worsened to 20/60 after a slow steroid tapper. At that time OCT showed foveal thickening and cystic changes specific for cystoid macular edema (CME). Combination of corticosteroid and non-steroidal anti-inflammatory drug four times daily was included in therapy. The dose was tapered off over the ensuing 8 weeks. The total treatment duration was 12 weeks. At the patient's 2-month follow-up visit, vision has improved to 20/20 and the fovea appeared flat. OCT showed complete resolution of foveal thickening and cystic changes. Combination of corticosteroid and NSAID is effective and safe therapy for treating pseudophakic CME. Patient showed significant improvement in visual acuity and retinal thickness at 2 months post treatment. Abbreviations: OCT - optical coherence tomography, CME - cystoid macular edema, NSAID - non-steroidal anti-inflamatory drugs. Reprinted by permission of Croatian Anthropological Society and Institute for Anthropological Research, Zagreb, Croatia
This study reports early outcomes of a cohort of presbyopic patients treated with Intracor. The study took place from December 2010 to May 2011 and was conducted in University Eye Hospital ..."Svjetlost", Zagreb, Croatia. 95 eyes were enrolled in this prospective clinical trial (49 patients with non dominant eye and 23 with bilateral treatment). All patients gave informed consent prior to enrollment. Follow up consisted of uncorrected and corrected distant and near visual acuity, record of topographic changes, visual disturbances and patient satisfaction at 1 week, 1 and 3 months after the surgery. In this study Intracor procedure presented as both safe and effective with all eyes gaining several lines of uncorrected near visual acuity (UNVA), and achieving good uncorrected distant visual acuity(UDVA) as well. UDVA was affected by a mild myopic shift, which was effective in reducing mild preexisting hyperopia in some patients but led to a mild myopic outcome in previously emmetropic patients. Statistically significant improvement in UDVA and UNVA was observed in all time points. At 3 months of postoperative follow up all patients gained several lines of UNVA with monocular UNVA Jaeger system 1.67 +/- 0.28. UDVA showed slight improvement over time and initial myopic shift showed tendency of slight decrease with all patients achieving 1.0. Overall patients satisfaction was very high (98%) with only a few (3 patients, 5 eyes) reporting mild halo and glare at 3 months postop.Intracor procedure has proven its short-term safety and efficacy in treating presbyopia. However, longer follow up period is needed.
Bullous keratopathy (BK) is a chronic corneal edema with or without subepithelial bullae as a result of a loss of the endothelial cells. 15 patients with BK after cataract surgery with intraocular ...lens implantation, due to Fuchs dystrophy (n = 3) or corneal endothelial trauma (n = 12) were included in the study. All patients were treated by amniotic membrane transplantation (AMT). Corneal epithelial cells in patients suffering from BK secreted 3.91 +/- 3.09 pg/mL of IL-1 alpha, 4446 +/- 16.8 pg/mL of TNF and 81.43 +/- 37.81 pg/mL of VEGF-I. Levels of all 3 investigated cytokines were significantly higher as compared to controls (p < 0.005). Amniotic membranes that were used to treat investigated patients contained 638.98 +/- 613.98 pg/mL of IL-1ra, 0.026 +/- 0.009 pg/mL of sTNF and 81.39 +/- 21.01 pg/mL of VEGF-R. Beneficial clinical effect of the AMT in treating BK could be explained by its natural production of pro-inflammatory cytokine antagonists such as IL-ra, sTNF antagonist and VEGF-R.
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