Secondary chronic open-angle glaucoma associated with pseudoexfoliation (PEX) syndrome accounts for approximately 25% of all glaucomas and represents the most common identifiable cause of glaucoma ...overall. Selective laser trabeculoplasty (SLT) is effective in reducing intraocular pressure (IOP) in glaucomatous patients and has the advantage of preserving surrounding structures. We report here SLT treatment of a 82 year old female with a secondary developed open-angle pseudoexfoliation glaucoma allergic to all anti glaucoma eye drops especially those which contain bensalconium chloridum as preservative. Since patient was allergic also to methyl-cellulose, we performed SLT with water as a mediator. Patient had PEX syndrome for 10 years, immature cataracts on both eyes, and best corrected visual acuity (BCVA) 0.7 on the right and 0.2 on the left eye. We have monitored intraocular pressure (IOP), the changes in the visual field and optic nerve. Preoperative IOP was 28 mmHg on the right and 30 mmHg on the left eye. The follow up period was 24 months with time points for measured parameters every 3 months. After 18 months IOP remained in the normal values (average17 mmHg) on the right eye, but on the left eye it increased up to 28 mmHg. SLT re-treatment was carried out on the left eye and the IOP stabilized again on the values between 16-18mmHg. There were no significant change in the visual field and optic nerve configuration before and after SLT (C/D value for right eye:0.3–0.4; C/D left eye:0.5). Based on this case report, SLT seems to be very effective treatment for maintaining regular IOP in patient with PEX who is allergic to all types of medications.
Amniotic membrane transplantation (AMT) leads to reduction of inflammatory symptoms and causes faster epithelisation
in corneal ulcers and persistant epithelial defect. 21 patients with corneal ulcer ...(n=18) or non-healing epithelial
defect (n=3) unresponsive to conventional treatment were included in the study. All patients were treated by AMT.
Corneal epithelial cells in patients suffering from corneal ulcer secreted 3.51±1.79 of IL-1a, 64.27±31.53 pg/mL of TNFa
and 209.07±201.82 pg/mL of VEGF. Levels of all 3 investigated cytokines were significantly higher as compared to controls
(p<0.005). Amniotic membranes that were used contained 775.69±613.98 pg/mL of IL-1ra, 0.036±0.033 pg/mL of
sTNF and 175.01±166.63 pg/mL of VEGF-R. Supporting effect of the AMT could be explained by the fact that AM secretes
its natural antinflammatory antagonists IL-1ra, sTNF and VEGF-R.
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.
Multifocal intraocular lenses (MFIOL) enable good near and far vision after cataract surgery. Excellent results with
cataract patients encouraged ophthalmologists to implant MFIOL after clear lens ...extraction (CLE). There are two types
of MFIOL: diffractive and refractive. In our prospective study we compared clinical outcomes after CLE and bilateral implantation
of diffractive (Tecnis Multifocal), (N = 100 eyes, 50 patients) and refractive (ReZoom), (N = 100 eyes, 50 patients)
MFIOL to patients with presbyopia and hyperopia. Near and distant uncorrected visual acuity (UCVA), spectacle
dependency, subjective satisfaction and visual disturbances were measured and compared between two groups. Patients
achieved good near and distant UCVA in both groups. »Tecnis« group had better near UCVA (statistically not significant)
and less night time visual disturbances. »ReZoom« group reported less problems with intermediate vision. Diffractive
and refractive MFIOL enable high rate of spectacle independency to presbyopic hyperopic patients with low rate of
side-effects. Refractive MFIOL provide better intermediate vision and diffractive slightly better near vision and less haloes
and glare.
Amniotic membrane transplantation (AMT) promotes rapid epithelialization and reduces stromal inflammation and
ulceration in HSV-1 keratitis. 18 patients with non-healing epithelial defect or corneal ...ulcer caused by herpetic keratitis
were included in the study. All patients were treated by AMT. Corneal epithelial cells in patients suffering from herpetic
keratitis secreted 5 ± 4.8 pg/ml of IL-1a and 0.16 ± 0.47 pg/ml of IL-1b (mean ± SD). IL-1a level was significantly higher
as compared to controls (p<0.005). Amniotic membranes that were used to treat investigated patients contained 339.87 ±
105 pg/ml of IL-1ra. In herpetic keratitis pro-inflammatory cytokine IL-1a is secreted from corneal epithelial cells in significantly
higher level then in controls. Beneficial effect of the AMT in such patients could be explained by the fact that
AM secretes its natural antagonist IL-1ra.
Cilj: Keratokonus je najčešća indikacija za transplantaciju rožnice u razvijenim zemljama
svijeta s najboljim ishodom i s najmanjim brojem komplikacija. Cilj rada bio je istražiti brzinu
oporavka, ...najbolju korigiranu vidnu oštrinu i komplikacije koje se javljaju u prvoj godini nakon
operacije perforativne keratoplastike (PK) u bolesnika s keratokonusom. Metode i
bolesnici: Ova prospektivna studija obuhvaća 38 bolesnika s keratokonusom podvrgnutih perforativnoj
keratoplastici u Specijalnoj bolnici za oftalmologiju Svjetlost u godinu dana. U 31
bolesnika transplantacija je učinjena prvi put dok je u 7 bolesnika ovakva vrsta operacije već
učinjena na drugom oku. Svi operirani bolesnici imali su preoperativnu vidnu oštrinu ≤ 0,3 te
nisu više mogli nositi kontaktnu leću. Rezultati: Bistar transplantat nakon prvih 6 mjeseci imalo
je 100 % bolesnika, a nakon 1 godine 97,7 %. Prosječna najbolje korigirana vidna oštrina
(BCVA) nakon prvog mjeseca iznosila je 0,53 ± 0,23 (P < 0,001), a nakon 6 mjeseci 0,69 ± 0,22
(P < 0,001). Podaci za godinu dana nakon PK prikupljeni su za 25 bolesnika čija je prosječna
BCVA bila 0,81 ± 0,14 (P < 0,001). Od postoperativnih komplikacija najčešći je bio visoki postoperativni
astigmatizam (> 4 dcyl) u 44,7 % bolesnika, potom reakcija odbacivanja transplantata
u 13,2 % bolesnika, povišen očni tlak u 5,2 %, mrena u 2,6 % i odbačeni transplantat u 2,6 %
bolesnika. Rasprava: Iako se lamelarna keratoplastika sve češće spominje kao metoda izbora
pri liječenju uznapredovanog keratokonusa, u ovoj smo studiji pokazali da i rezultati nakon
klasične perforativne keratoplastike imaju visok postotak uspješnosti. Zaključak: Perforativna
keratoplastika efikasna je metoda liječenja bolesnika s uznapredovanim keratokonusom radi
postotka uspješnosti od 97,7 % te malog broja komplikacija.
The loss of the corneal endothelial cells, especially in a first postoperative year, has been observed in patients who underwent penetrating keratoplasty (PK). The implantation of new generation of ...»iris claw« phakic IOL (Verisyse) in refractive cases has been shown to cause clinicaly insignificant endothelial cell loss. In our prospective case series we investigated the endothelial cell loss and clinical outcome in patients that either underwent PK and implantation of PCIOL or PK and implantation of Verisyse IOL. In the first group of 9 patients scheduled for PK, implantation of Verisyse was performed due to the absence of the posterior capsule support. 2 of these patients had angle supported ACIOL, 4 patients were aphakic and 3 had posttraumatic cataract with ruptured posterior capsule. The second group of 12 patients had standard »triple« procedure (PK + ECCE + PCIOL). BCVA of both groups of patients prior the operation was hand movement in 12 patients, light perception in 7 patients and 0,05 in 3 patients. The preoperative endothelial cell count of the donor grafts obtained from the eye bank was 2800 cells/mm2 on average. The follow up was 6–10 months. Six months after the operation all »Verysise« patients maintained transparent graft. Postoperative visual acuity improvement was recorded in 18 out of 21 eyes (85,7 %). Best spectacle corrected visual acuity of ł0,3 was achived in 55,5% in the Verisyse group and in 50,0% of »triple procedure« group. The endothelial cell count and morphology were estimated on the specular microscope on a monthly basis. Mean endothelial cells loss in patients with PK and Verysise was 40± 8% and in patients with »triple« procedure was 42±12% at 10 postoperative months. There was no significant difference in the endothelial cell loss and clinical outcome between the group of patients who had PK and Verysise as compared to those with implanted PCIOL.
Fungal keratitis represents one of the most difficult forms of microbial keratitis to diagnose and treat successfully. It is difficult to obtain correct diagnosis and topical antifungal preparations. ...Fungi can cause severe stromal necrosis and enter the anterior chamber by penetrating an intact Descemet membrane. The most common pathogens are filamentous fungi (Aspergillus and Fusarium spp.) and Candida albicans. The incidence of Trichophyton spp. keratitis is 5%. A 22 years old female contact lenses wearer after keratitis developed corneal melting syndrome, spontaneous perforation of the cornea and complicated cataract of the left eye. Conjunctival swab was sterile as well as first sample of corneal tissue and sample from the anterior chamber. Urgent therapeutic perforating keratoplasty (PK), was performed together with extracapsular cataract extraction and the implantation of the intraocular lens in the posterior chamber. The patient was treated with ciprofloxacin and diflucan (systemic therapy); with dexamethason and atropin (subconjunctivaly) and chlorhexidine, brolene, levofloxacin, polimyxin B, and dexamethason/neomycin (topically). Microbiology evaluation was performed once again following excisional biopsy of the intracameral portion of the lesion. The presence of Trichophyton spp. was finally confirmed. Itraconazole and garamycin were included in the systemic therapy. Corneal graft was clear for 17 days but decompesated 28 days after the PK. After two weeks microorganisms invaded the vitreous and caused endophthalmitis. Despite urgent pars plana vitrectomy patient developed endophthalmitis, lost light sensation and developed phthysis. Evisceration and the implantation of silicon prosthesis was done. Perforating keratoplasty is a method of choice in treating severe infectious keratitis unresponsive to conservative tretment but without the eradication of microorganisms it cannot restore the vision or save the eye. Trichophyton spp. may cause a severe disease of the anterior and posterior part of the eye which may finish with the lost of vision/eye. Prompt diagnosis and treatment of Trichophyton spp. keratitis are essential for a good visual outcome.
There are several methods for presbyopia treatment. Refractive lens exchange (RLE) followed by multifocal intraocular lens (MFIOL) implantation enables high rate of spectacle independance but have ...some visual disturbances. Laser in Situ Keratomileusis (LASIK) monovision gives patient ability to have good distant vision with dominant eye and good near vision with nondominant eye. In this prospective randomized study we wanted to compare clinical outcomes in patients who underwent either of the mentioned procedures. The first group included 50 patients (N=100 eyes) who underwent RLE with MFIOL implantation and the second group included 50 patients (N=100 eyes) who underwent LASIK monovision as presbyopia treatment. Uncorrected distant, near and intermediate visual acuity, patient’s subjective satisfaction and visual disturbances were measured. Follow up was 6 months. Patients in RLE group had better near uncorrected visual acuity (UCVA) and patients in LASIK monovision group had better distant and intermediate vision. Patients in RLE group reported visual disturbances (halo, glare). Patients satisfaction and spectacle independance was high in both groups. Refractive lens exchange with multifocal intraocular lens implantation and LASIK monovision are effective methods for presbyopia treatment. LASIK monovision with –0.50D – 1.25D of residual dioptry at nondominant eye in patients under 50 years enables good vision at all distances without affecting stereovision. Patient selection and preoperative counseling are key to success.
Abbreviations: RLE – refractive lens exchange, MFIOL – multifocal intraocular lens, LASIK – laser in situ keratomileusis, UCVA – uncorrected visual acuity, IOL – intraocular lens.
