One of the most important factors for successful intraocular surgery is deep anterior chamber which is maintained using viscoelastics that protect corneal endothelial cells. This single endothelial ...cell layer may sustain a varying degree of injury during surgery and is known to be incapable of regeneration.
Of the study was to determine optimal visoelastics for the protection of corneal endothelial cells during phacoemulsification and intraocular lens implantation.
A series of 156 patients were included in this prospective study. Patients were randomly assigned to three groups based on the type of viscoelastics used. In the first group, 1.4% sodium hyaluronate, in the second group a combination of 4% sodium chondroitin sulfate and 3% sodium hyaluronate, and in the third group 3% hyaluronate was used. Endothelial cell count and morphology changes were determined centrally with a specular microscope on the day before, on day 7 and one month after surgery. Intraocular pressure was measured before surgery, and at 6 hours, 24 hours, 7 days and 30 days of the surgery. Pachymetry as a measure of "endothelial pump" function was evaluated before surgery and 7 and 30 days postoperatively. All surgeries were performed by two surgeons using the same technique.
Endothelial cell loss was lowest (16.1%) in the eyes protected with a combination of 4% sodium chondroitin sulfate and 3% sodium hyaluronate. In the groups where 1.4% sodium hyaluronate and 3% hylunorate were used, the loss was 7.6%; and 7.9%, respectively. Although endothelial cell loss was not significantly different among the three groups, the lowest morphology change rate recorded in group 2 suggested that a combination of chondroitin and hyaluronate offered the best endothelial protection. There was no statistically significant difference in the postoperative intraocular pressure increase and pachymetry values among the study groups.
In 25 eyes, age range 60–80 years, in purpose of preoperative treatment prior to cataract surgery, measurements of the radius of curvature as well as main meridians of the anterior and posterior ...corneal surfaces were performed. Average value of the curvature of the anterior corneal surface (R1) was R1=7.84 mm, while posterior radius (R2) was 6.4mm. Main meridian of the anterior corneal surface was in 70% in plus value (+), while postrerior main meridian was always in minus value. It is very important to highlight that main corneal meridians R1 and R2 always cross outside the 90° angle. That is why the combination of the calculation based on the two main meridians superposition (overrefraction) as a form of crossed cylinders has to be calculated (Astigmatismus directus seu obliquus decusatus) using special formula. One of that kind of formulas is Thompson’s. Authors want to emphasise the importance of the optical calculation of the posterior corneal surface in the refractive surgery.
The aim of this study is to compare complication rates in two different operative techniques applied for the secondary, posterior chamber intraocular lens (PCIOL) implantation with sulcus fixation. ...179 eyes with partial or no posterior capsule support underwent surgery. Applied techniques were: transscleral fixation of the IOL by passing with the fixation needle through the sulcus from the inside (70 eyes) or from the outside (109 eyes) of the bulbus. The most frequent intraoperative complications were haemorrhages and vitreous prolaps with no significant difference between used techniques. In the 'from the inside' group, following late postoperative complications developed: astigmatism of > 4D (24%), cystoid macular oedema (20%), pupil distortion (14%), partial posterior capsule opacification (10%), suture exposure (10%), IOL decentration (8%) and hemophthalmus (3%). In the 'from the outside' group same complications showed a decreased rate: 17%, 16%, 8%, 8%, 9%, 5% and 1%, respectively. Other late complications like high intraocular pressure, synechiae and uveitis were adequately represented in both techniques. After 24 months follow-up, best corrected visual acuity > or = 0.8 was achieved in 48.5% of eyes when 'from the inside' and in 57.7% of eyes when 'from the outside' technique was used.
To determine the effect of topical soluble tumor necrosis factor receptor type I (sTNFR-I) on survival of murine orthotopic corneal transplants and on ocular chemokine gene expression after corneal ...transplantation.
BALB/c mice (N = 50) were used as recipients of multiple minor H-disparate corneal transplants from B10.D2 donors. After orthotopic corneal transplantation, mice were randomized in a masked fashion to receive either topical sTNFR-I or vehicle 3 times daily, and all grafts were evaluated for signs of rejection and neovascularization by slitlamp biomicroscopy for 8 weeks. Ocular chemokine gene expression in sTNFR-I- and vehicle only-treated groups was determined using a multiprobe ribonuclease protection assay.
Hosts treated with topical sTNFR-I experienced significantly enhanced corneal allograft survival compared with animals treated with vehicle alone (P =.01). Moreover, postoperative messenger RNA levels of RANTES and macrophage inflammatory protein-1beta in sTNFR-I-treated eyes were substantially suppressed compared with vehicle-treated eyes. Vehicle-treated eyes bearing rejected allografts expressed higher levels of messenger RNA for both chemokines than control eyes bearing accepted allografts.
Topical treatment with sTNFR-I promotes the acceptance of allogeneic corneal transplants and inhibits gene expression of 2 chemokines (RANTES and macrophage inflammatory protein-1beta) associated with corneal graft rejection.
Our findings support the feasibility of a topical anticytokine strategy as a means of reducing corneal allograft rejection without resorting to the use of potentially toxic immunosuppressive drugs.
Diabetic macular edema is the leading cause of moderate visual deterioration in patients with diabetic retinopathy.
Ranibizumab) blocks vascular endothelial growth factor (VEGF) induced ...hyperpermeability of blood vessels. In this prospective
case series we investigated the efficacy and safety of anti-VEGF treatment in reduction of central retinal thickness
(CRT) and improvement in visual acuity (VA) in patients with diabetic macular edema (DME). 9 patients were followed
up for 6 months and treated monthly with intravitreal ranibizumab. VA and CRT were measured at each visit.
Treatment was discontinued as the peak improvement of either parameter was reached and reinstituted in case of deterioration/
recurrence of edema. Study endpoints included: VA using ETDRS chart, CRT and number of injections at 6
months. Mean VA from all 9 patients increased by 0.3 lines of logMAR (p<0.05 compared to baseline), and CRT decreased
from 515 ± 123 mm to 310 ± 110 mm. The improvement of VA after ranibizumab injection was in correlation with
a decrease in CRT. Mean of 4 injections were needed to control the disease during the follow-up period. Ranibizumab
treatment was effective in VA and reducing CRT. Several injections were needed to control the disease. Regular OCT examinations
and retreatment are advised in order to maintain initially reached VA.
Abbreviations: DME – diabetic macular edema, VEGF – vascular endothelial growth factor, CRT – central retinal
thickness, VA – visual acuity, ETDRS – early treatment diabetic retinopathy study, OCT – optical coherence tomography,
SOCT – spectral domain optical coherence tomography, IDDM – insulin dependent diabetes mellitus, NIDDM – non-insulin
dependent diabetes mellitus.
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.
Abbreviations: UNVA – uncorrected near visual acuity, UDVA – uncorrected distant visual acuity
High endothelial cell densitiy (ECD) is essential for the corneal graft clarity. We evaluated ECD loss in 120 eyes that
underwent penetrating keratoplasty (PK) in Eye Clinic Svjetlost in a one year ...follow up period. Patients were divided
into 3 groups of high (N=35), intermediate (N=31) and low risk (N=54) for graft failure. Postoperative central endothelial
density, coefficient of variation in cell area (polymegathism), percentage of hexagonal cells (pleomorphism) in comparison
to preoperative donor cell measurements were determined in the following postoperative time-points of 1, 2, 3, 6,
9 and 12 months. There were no significant differences in the preoperative ECD values, storage time, donor age or surgical
procedures between groups. Throughout all time points intermediate group had the greatest statistically significant
ECD loss as compared to high and low risk groups. There were no significant differences between high and low risk
group. After 12 month post PK, intermediate risk group had 28.38% ECD loss as compared to 24.07% in high and
23.03% ECD loss in low risk group. Coefficient of variation in cell area (CV) was for high risk group 0.34, intermediate
0.40 and low risk 0.31 which was not significantly different between groups. Percentage of plemorphism in high risk was
54%, intermediate 58% and in low risk 48% which was significantly different as compared to other two groups. Our
study showed that corneal pathology is among others, very important prognostic factor for ECD after PK. However, longer
follow up period is needed.
Abbreviations: ECD – Endothelial cells density, PK – penetrating keratoplasty, CV – Coefficient of variation in cell
area
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-inflammatory
drugs
It has been shown that amniotic membrane transplantation (AMT) improves healing of the epithelium defects as it serves as a basement membrane for endothelial cells growth, prevents inflammatory cell ...infiltration and reduces apoptosis in keratocytes. Having in mind the healing properties of AM we investigated the efficacy of AMT in persistent epithelial defect (PED) on the corneal graft. 80 corneal grafts were prospectively followed up for presence of PED 10 months after surgery. PED was detected in 12 cases (15%) having surgery for: rejected graft (n=4), keratoconus (n=3), keratoconus following PK on a second eye (n=3), corneal perforation (n=1) and Stevens-Johnson keratopathy (n=1). Epithelial defect (ED) developed 14±7 days after surgery in 10 cases and 1,5 month in other two. All patients were primarily conservatively treated with subconjuctival steroids and artificial tears for 10 days and systemic steroid therapy if needed after, until the period of 2 weeks. 4 patients were healed. Since ED was unresponsive to all previous treatments for more then 2 weeks, one layer of AM was placed on the corneal lesion in 5 patients, and in 3 cases of deep PED several layers of AM were placed. Healing of the defect was obtained in 7/8 (87.5%) eyes. In 1 patient second AM transplantation was necessary. Mean epithelization time was 2 weeks (range 1–3 weeks) in monolayer and 3 weeks (range 2–4 weeks) for multilayer cases. 5 out of 8 patients retained the same best corrected visual acuity (BCVA) while 3/8 patients improved their vision more than 2 lines. Preoperative corneal thickness of 255±40 mm increased to 455±90 mm. AM transplantation facilitates healing of corneal epithelium. PED on the corneal graft unresponsive to conventional treatment can be effectively cured when covered with one or more amniotic membrane layers.
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