Iva Dekaris

Early expression of proinflammatory cytokines interleukin-1 and tumor necrosis factor-alpha after corneal transplantation.

This studys aim was to determine the early postoperative expression of proinflammatory cytokines interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) by corneal grafts. BALB/c (n = 90) and C57BL/6 (n = 90) murine recipients were grafted with donor corneas from either syngeneic or allogeneic mice. At 7 and 14 days after surgery, corneal grafts were excised and the recipient rims separated from the donor tissue. Corneal segments were cultured and assayed for cytokines by enzyme-linked immunosorbent assay (ELISA). There was profound upregulation in expression of both IL-1alpha and TNF-alpha after corneal transplantation. Among both low-rejecting BALB/c and high-rejecting C57BL/6 hosts, levels of IL-1alpha were significantly (p < 0.01) more marked in allogeneic as compared to syngeneic grafts. TNF-alpha overexpression was similarly more marked in allogeneic as compared to syngeneic grafts in both BALB/c and C57BL/6 hosts, although the difference was generally more marked among high-rejecting C57BL/6 recipients. In the case of both IL-1alpha and TNF-alpha, the principal source of cytokine expression in the transplanted tissue was the recipient rim. There is significant overexpression of both IL-1alpha and TNF-alpha during the first 2 weeks after transplantation in both syngeneic and allogeneic orthotopic corneal grafts. However, whereas in syngeneic grafts cytokine expression generally decreases after the first postoperative week, significantly elevated cytokine levels are sustained in allogeneic grafts, implicating IL-1 and TNF-alpha as mediators of the alloimmune response in corneal transplantation.

Vector analysis of astigmatism before and after LASIK: a comparison of two different platforms for treatment of high astigmatism

PurposeTo compare the outcomes of astigmatic laser in-situ keratomileusis (LASIK) procedures between two different platforms using J0 and J45 vector analysis.MethodsPatients were divided into four groups, depending on the type of astigmatism and laser platform on which they were treated. Astigmatism was between 2 and 7 diopters (D). One hundred and thirty-five patients with myopic astigmatism (246 eyes) and 102 patients with mixed astigmatism (172 eyes) underwent unremarkable LASIK correction on Wavelight Allegretto Eye-Q 400Hz and Schwind Amaris 750S laser platform. The preoperative and postoperative sphere, negative cylinder [C] and axis (ø) of manifest refractions were subjected to vector analysis by calculations of the standard J0 (cos [4π(ø-90)/360]xC/2) and J45 (sin[4π(ø-90)/360]xC/2).ResultsReporting the key results, we found J0 significantly reduced after LASIK in both groups (p < 0.001) but not J45. There was no significant association between individual pairs of pre and postoperative J0 & J45 values. There was no significant difference between the outcomes of the two platforms.ConclusionsWavelight Allegretto 400Hz and Schwind Amaris 750S showed excellent results for treating patients with astigmatism, regardless whether it is mixed or myopic astigmatism. The J45 did not reduce significantly possibly because of the low number of eyes with oblique astigmatism. There was no genuine difference post-operatively between groups treated on two different laser platforms according to the vector analyses.

Vascular Endothelial Growth Factor in a Recipient Cornea Acts as a Prognostic Factor for Corneal Graft Reaction Development

Abstract Purpose: To evaluate whether the vascular endothelial growth factor A (VEGF-A) in the recipient cornea measured at the time of penetrating keratoplasty (PK) can act as a prognostic factor for corneal graft reaction development. Methods: The study included 25 eyes (of 25 patients) scheduled for PK. According to preoperative clinical finding, patients were divided into three groups: inflammatory with neovascularization (n = 11); inflammatory without neovascularization (n = 7); and non-inflammatory (n = 7). One half of the recipient cornea was analyzed for the levels of VEGF-A protein using a commercial enzyme-linked immunosorbent assay; the other half was analyzed to determine the loci of VEGF-A production by immunohistochemistry. The frequencies of corneal graft reaction and rejection were recorded, together with the improvement of visual acuity. Twenty-five donor corneas obtained from cadaver eyes represented the control group (n = 25). Results: There was a statistically significant difference in the levels of VEGF-A protein between the recipient corneal buttons obtained from eyes with inflammatory changes and neovascularization, and those from the non-inflammatory group and controls (p < 0.01). The level of VEGF-A was 287.74 pg/ml (standard deviation [SD] = 129.181) in the inflammatory with corneal neovascularization group, 227.64 pg/ml (SD = 85.590) in the inflammatory without neovascularization group, 115.37 pg/ml (SD = 105.93) in the non-inflammatory group, and 142.28 pg/ml (SD = 93.081) in the control group. Graft reaction/rejection rate was 54.5%/45.5% in the inflammatory with neovascularization group, 14.3%/0% in the inflammatory without neovascularization group, and 14.3%/14.3% in non-inflammatory group. Patients who developed clinical signs of graft reaction during the postoperative follow-up had a significantly higher level of VEGF-A (307.4 pg/ml, SD = 100.058) compared with those without any signs of graft reaction (182.8 pg/ml, SD = 124.987). Conclusion: Our results suggest that both graft reaction and final graft rejection occur more often in patients with increased levels of VEGF-A in a recipient cornea at the time of PK.

Ultra-thin descemet stripping automated endothelial keratoplasty (UT-DSAEK) – Why I prefer this technique

Subjects & Methods: Ninety five patients (204 eyes) underwent bilateral trifocal IOL (AT LISA tri 839MP, Zeiss, Germany) implantation after clear lens extraction. Patients were presbyopes; 95 hypermetropes and 7 myopes between 46 and 68 years. Other 20 eyes with hyperopic or myopic astigmatism received trifocal toric IOL (AT LISA tritoric 939 MP, Zeiss, Germany). Uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity at 80 cm (UCIVA), uncorrected near visual acuity (UCNVA), uncorrected distance visual acuity under 10% contrast level, visual disturbances and subjective satisfaction were measured and compared to Bifocal group (AT LISA 809MP; 42 pts, 84 eyes). Follow up was at least 6 months, up to two years.

Refractive lens exchange with implantation of trifocal or trifocal toric intraocular lens

Subjects & Methods: Ninety five patients (204 eyes) underwent bilateral trifocal IOL (AT LISA tri 839MP, Zeiss, Germany) implantation after clear lens extraction. Patients were presbyopes; 95 hypermetropes and 7 myopes between 46 and 68 years. Other 20 eyes with hyperopic or myopic astigmatism received trifocal toric IOL (AT LISA tritoric 939 MP, Zeiss, Germany). Uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity at 80 cm (UCIVA), uncorrected near visual acuity (UCNVA), uncorrected distance visual acuity under 10% contrast level, visual disturbances and subjective satisfaction were measured and compared to Bifocal group (AT LISA 809MP; 42 pts, 84 eyes). Follow up was at least 6 months, up to two years.

Successful Treatment of Postkeratoplasty Fungal Keratitis with Topical and Intrastromal Voriconazole

Objective: Corneal grafts have a major risk of fungal keratitis due to long-term local and sometimes systemic steroid/antibiotic use. The aim of this study was to evaluate the efficacy of intrastromal voriconazole as a therapeutic adjunctive for the management of fungal keratitis in corneal graft. Design: Presentation of two cases of fungal keratitis occurring after corneal transplantation and treated at the University Eye Hospital “Svjetlost”. Participants and Methods: Two cases of postkeratoplasty fungal keratitis are presented in the study. Both patients had decreased visual acuity, eye redness and severe pain occurring at 10 and 12 months after uneventful corneal transplantation. They were still receiving steroid/antibiotic topical treatment to protect their corneal graft. Patients presented with a stromal infiltrate in a donor tissue, accompanied with corneal ulcer at recipient/donor junction. Candida infection was proven by corneal scraping. Topical and systemic antimycotic treatment was started, fortified by intrastromal injection of voriconazole (50 μg/0.1 ml) given all around the junction of clear cornea and infiltrate (or ulcer). Results: One week after injection, corneal ulcers had healed and corneal infiltrates decreased; resulting in visual acuity improvement from 20/100 to 20/20 in first, and from 20/80 to 20/40 in a second case. One year after infection visual acuity in the first case remained 20/20, and improved to 20/20 in a second case. Conclusion: Intrastromal voriconazole seems to be a safe method for providing a higher concentration of the drug in the cornea affected by fungal keratitis; it can serve as an adjunctive treatment to topical and systemic antifungal therapy.

Descemet Stripping Automated Endothelial Keratoplasty – Is a Thinner Donor Lamella the Better Choice?

Introduction:To evaluate the influence of lamellar thickness on visual recovery after Descemet stripping automated endothelial keratoplasty (DSAEK) and compare the results to penetrating keratoplasty (PK). Methods:A prospective case series of 20 eyes with pseudophakic bullous keratopathy (PBK) undergoing DSAEK.Lamellar graft thickness was measured at the visual axis using anterior segment OCT, by the same person, at various time points after DSAEK. Eyes were divided into groups based on Day One postoperative endothelial lamella thickness: standard (≤180 μm), medium-thick (>180 ≤ 250 μm) and thick (>250 μm). Outcome measurements were graft survival rate, best spectacle-corrected visual acuity (BSCVA), endothelial cell density loss (ECD), and degree of astigmatism. Results in DSAEK eyes were compared to 20 PBK eyes which underwent PK. Results:The median postoperative graft thickness of DSAEK eyes was 194.54 ± 47.61 μm. There was no significant difference in age, sex, or preoperative BSCVA between DSAEK groups. The postoperative follow-up period was 18 months. Eyes with lamellar grafts of ≤180 μm thickness showed better postoperative BSCVA and quicker recovery rates compared to the medium-thick and thick grafts (P<0.001). Only eyes receiving ≤180 μm thickness lamellar grafts achieved equivalent BSCVA as PK eyes at month 18. Medium-thick grafts needed a longer period to obtain BSCVA scores similar to thinner grafts, while thick grafts never achieved the BSCVA of standard and PK grafts. All DSAEK eyes with lamella of thickness ≤180 μm, and only 50% of those with medium-thick lamella, had reached a BSCVA of ≥ 0.5 at 6 months. Conclusions: Lamella of thickness ≤180 μm after DSAEK ensured a better and quicker visual recovery than thicker grafts.