Dorota Tarnawska

Management of pseudophakic bullous keratopathy by combined Descemet-stripping endothelial keratoplasty and intraocular lens exchange

PURPOSE: To evaluate visual recovery results in 11 patients with anterior pseudophakia and corneal endothelial dysfunction who had Descemet‐stripping endothelial keratoplasty (DSEK) combined with anterior chamber intraocular lens (IOL) removal and scleral fixation of a posterior chamber IOL. SETTING: Department of Ophthalmology, District Railway Hospital Katowice, Katowice, Poland. METHODS: Eleven consecutive patients had DSEK combined with IOL exchange. Corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD), visual outcomes, and complication rates were measured during the follow‐up. RESULTS: The mean age of patients was 76 years. All corneas remained clear during the mean 19.3‐month follow‐up. At the last visit, the mean uncorrected visual acuity was 0.16 (range 0.001 to 0.50) and the mean best corrected visual acuity, 0.36 (range 0.001 to 0.80). The mean spherical equivalent was +0.30 diopter (D) (range −2.00 to +2.25 D) and the mean astigmatism, 2.20 D (range 1.25 to 3.00 D). Three eyes with endothelial disk detachment required reinjection of air. Corneal rejection was observed in 1 eye 3 months postoperatively. Two eyes had flap erosion over the fixation suture. The mean CCT was 0.837 μm preoperatively and 0.605 μm postoperatively. The mean ECD was 3198 cells/mm2 in donor lenticules and 2048 cells/mm2 at the last follow‐up visit. Endothelial cell loss was 36%. CONCLUSION: Descemet‐stripping endothelial keratoplasty combined with anterior chamber IOL replacement with a scleral‐fixated posterior chamber IOL was a safe method for the management of pseudophakic bullous keratopathy.

Comparison of Three Intraocular Pressure Measurement Methods Including Biomechanical Properties of the Cornea

PURPOSE The aim of this study was to show the usefulness of three methods for measuring IOP: Goldmann applanation tonometry, rebound tonometry, and Ultra-High-Speed Scheimpflug technology. METHODS The examined group consisted of 96 patients (192 eyes), including 63 women and 33 men with a mean age of 59.3 ± 19.9 years. Together, 152 healthy eyes and 40 eyes with different pathologies were examined. Intraocular pressure was measured using the Goldmann applanation tonometer (GAT), the Icare Pro rebound tonometer (RT), and Ultra-High-Speed Scheimpflug technology (UHS ST; Corvis ST with pachymetry). Additionally, corneal pachymetry was conducted with a Scheimpflug camera (Pentacam) and an Ultrasound Pachymeter (A-scan Plus) as a comparison for Corvis ST pachymetry. RESULTS The mean IOPs were 15.6 ± 3.75 mm Hg, 15.6 ± 3.5 mm Hg, and 16.1 ± 4.0 mm Hg when measured with the GAT, the RT, and the UHS ST, respectively. The mean central corneal thickness (CCT) was 543.7 ± 52.7 μm, 547.9 ± 54.0 μm, and 556.25 ± 38.8 μm as measured with the UHS ST, the Pentacam, and the Ultrasound Pachymeter, respectively. In comparison between devices, there was a significant difference between IOP values measured with the GAT and the RT versus the UHS ST (P < 0.001), and there was no significant difference between GAT and RT (P = 0.5). No significant differences were observed in CCT measured with the UHS ST, Pentacam, and Ultrasound Pachymeter. CONCLUSIONS We showed that the RT Icare Pro ensures IOP measurements that are more comparable with the measurements obtained with the GAT than the measurements that are provided by UHS ST.

Anterior segment optical coherence tomography in eye injuries.

BackgroundTo evaluate the usefulness of anterior segment optical coherence tomography (AS OCT) for initial diagnosis and for monitoring treatment results in eye injury cases.MethodsWe examined 38 eyes of 34 patients with different types of ocular injuries: penetrating injury (eight eyes), perforating injury (two eyes), intraocular foreign body (four eyes), ocular burn (nine eyes), contusion (13 eyes), and lamellar laceration (two eyes). The mean age of the patients was 33.8 years. AS OCT examination was performed at the initial visit, directly after injury, and repeated as treatment progressed. Both anterior chamber components and corneal pachymetry were evaluated.ResultsSlit-lamp examination did not provide a clear diagnosis in three eyes after contusion because of a nontransparent cornea. In one case of a 44-year-old male patient, only corneal edema was noticed during slit-lamp examination, whereas AS OCT revealed Descemet’s membrane detachment. In a 17-year-old male patient with blood infiltrating the cornea, OCT revealed acute angle closure with a pupillary block. In patients with corneal burns, OCT was valuable for monitoring the corneal healing progress after amniotic membrane application. OCT was also useful for determining whether a lamellar or penetrating technique should be applied in patients that qualified for corneal transplantation. In patients with foreign bodies, AS OCT was helpful in establishing the localization and size of the foreign body.ConclusionsAS OCT is a very valuable tool in ophthalmic departments dealing with ocular trauma, for early diagnosis and for monitoring treatment progress.

Monitoring cornea and graft morphometric dynamics after descemet stripping and endothelial keratoplasty with anterior segment optical coherence tomography.

Purpose: To evaluate the dynamics of cornea and graft thickness after Descemet stripping and endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) and to assess the usefulness of AS-OCT in monitoring graft adherence after DSEK. Methods: Eighty-eight eyes from 86 patients underwent DSEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Central corneal thickness (CCT), endothelial graft thickness (GT), interface fluid presence, graft dislocation, rate of CCT, and GT changes were measured with an AS-OCT during 12-month follow up. Results: The CCT averaged 788 μm preoperatively. On postoperative Day 1, mean CCT was 816 μm and GT was 191 μm. Compared with CCT on the first day, the changes in CCT on 2, 3, and 7 days were statistically nonsignificant. From 1 month to 12 months after DSEK, the CCT significantly diminished (P < 0.001). The CCT dynamics closely correlated with changes of GT and of the recipients part of cornea. The most rapid rate of thickness decrease was observed between 1 week and 1 month: 5.34 μm/day for the entire cornea and 2.54 μm/day for endothelial disc. Between 1 month and 1 year, the CCT and GT were stable with only a trend toward further decrease. Entrapped fluid at graft/host interface on the first postoperative day was detectable by slit-lamp examination in 14 eyes (16%) and in 28 eyes (32%) in OCT. Conclusion: The recovery of endothelial pump after DSEK takes place between 1 week and 1 month after DSEK. AS-OCT can be practically used for evaluation of the cornea dynamics as well as for the qualitative and quantitative assessment of graft-host interface after DSEK.

New insight into the shortening of the collagen fibril D-period in human cornea

Collagen fibrils type I display a typical banding pattern, so-called D-periodicity, of about 67 nm, when visualized by atomic force or electron microscopy imaging. Herein we report on a significant shortening of the D-period for human corneal collagen fibrils type I (21 ± 4 nm) upon air-drying, whereas no changes in the D-period were observed for human scleral collagen fibrils type I (64 ± 4 nm) measured under the same experimental conditions as the cornea. It was also found that for the corneal stroma fixed with glutaraldehyde and air-dried, the collagen fibrils show the commonly accepted D-period of 61 ± 8 nm. We used the atomic force microscopy method to image collagen fibrils type I present in the middle layers of human cornea and sclera. The water content in the cornea and sclera samples was varying in the range of .066–.085. Calculations of the D-period using the theoretical model of the fibril and the FFT approach allowed to reveal the possible molecular mechanism of the D-period shortening in the corneal collagen fibrils upon drying. It was found that both the decrease in the shift and the simultaneous reduction in the distance between tropocollagen molecules can be responsible for the experimentally observed effect. We also hypothesize that collagen type V, which co-assembles with collagen type I into heterotypic fibrils in cornea, could be involved in the observed shortening of the corneal D-period.

Longitudinal observation of the retinal nerve fibre layer in glaucoma patients treated with brimonidine combined with timolol or timolol alone

INTRODUCTION. The aim of the study was to evaluate the retinal nerve fibre layer (RNFL) thickness loss in primary open-angle glaucoma (POAG) patients treated topically with anti-glaucoma drops containing brimonidine and timolol combination or solely timolol. MATERIALS AND METHODS. Retrospective case series study of patients with POAG diagnosis followed up for a five-year period. Inclusion criteria were fulfilled by a group of 98 patients consisting of 53 combination and 45 monotherapy treatments. Intraocular pressure (IOP) at the level of 21 mm Hg or below for each measurement was observed in 52 patients, while incidences of pressure above 21 mm Hg were measured in 46 patients. POAG diagnosis was based on standard optical coherence tomography, IOP, and visual field examinations. RESULTS. Mean annual loss of RNFL thickness in the overall study group (if IOP levels are not taken into consideration) treated with timolol monotherapy was 1.8 ± 1.5 μm, while in group treated with brimonidine + timolol combination therapy it was 1.7 ± 1.5 μm (p > 0.05). In selected groups of patients with incidents of pressure rises, the mean annual loss of retinal nerve fibre layer thickness was 1.8 ± 1.6 and 1.9 ± 1.4 μm, respectively, for the monotherapy and combination therapy groups (p > 0.05). In the group of patients with no reported IOL rises, mean annual loss of RNFL thickness was 1.8 ± 0.9 and 1.1 ± 0.4 μm, respectively, for the monotherapy and combination therapy groups (p < 0.01). No significant differences were observed for the visual field mean deviation. CONCLUSIONS. POAG patients with low values of IOP might achieve slower progression of RNFL thinning on brimonidine combined with timolol therapy.

Cytoarchitecture of epithelial inflammatory infiltration indicates the aetiology of infectious keratitis

To analyse cytological features of corneal epithelium in infectious keratitis.

Atypical Regressive Corneal Endothelial Cysts in Long-Term Confocal Follow-Up: A Case Report

AbstractCorneal endothelium is formed of 1 layer of mitochondria-rich cubic cells whose main role is to maintain corneal transparency. Corneal endothelial disorders represent group of both inherited and noninherited and may affect proper vision.A 36-year-old male patient with suspicion of corneal endothelial dystrophy underwent visual acuity, intraocular pressure, the basic slit-lamp examination, anterior segment optical coherence tomography (AS-OCT) (Visante, Carl Zeiss Meditec, Dublin, CA), and corneal confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III, Heidelberg, Germany). During the 3-year observation the patient reported symptoms mainly in the right eye. Slit-lamp examination revealed endothelial changes, much more pronounced in the right eye. Examination by the AS-OCT Visante showed hyperreflective dots within the right corneal endothelium. In order to assess endothelial cell morphology, analysis using corneal confocal microscopy in vivo was performed. Scans revealed presence of single endothelial deposits and severe cell changes of different morphology in both eyes. In the right eye, less pronounced changes of the polymorphic structure—polygonal guttas in different stages, linear and branched loss with “nuclear-like” formations and accompanying sediments. In the left eye, severe homomorphous polygonal “guttas-like” changes with “nuclear-like” formations were observed. Endothelial cysts’ features were dynamically changing during follow-up time with different effects on the patients clinical state.Corneal confocal microscopy allows accurate imaging of the endothelial cells and their detailed characteristics. Structural changes within the endothelial cells are not always proportional to visual acuity and slit-lamp image. The presented case is an example of an unusual corneal endothelial syndrome with probably nondystrophic background due to observed dynamic state with regressive tendency.

Surgical approach in corneal perforations and deep ulcers

Purpose Outcomes of patch grafts in corneal perforations and deep ulcers.

Pars Plana Vitrectomy Foreign Body Extraction Assisted With a 24-Gauge Needle Tunnel

A 54-year-old man presented with corneal laceration, traumatized iris, small vitreous hemorrhage, lens opacity, and a 13-mm intraocular foreign body embedded in the retina. Pars plana vitrectomy and argon laser photocoagulation were performed. Using intraocular forceps, the object was forced into a 24-gauge needle that was inserted through the sclerotomy. The foreign body and the needle were removed from the eye. Phacoemulsification with foldable intraocular lens implantation in the ciliary sulcus was performed. Seven days after the surgery, the patients visual acuity was 20/20 with spectacle correction of -3.5 diopters. The use of a needle tunnel during pars plana vitrectomy should be considered in similar cases of large, irregular intraocular foreign bodies to avoid severe and irreversible damage to the adjoining tissues.