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Purpose: To report the recurrence of a macular corneal stromal dystrophy 50 years after penetrating keratoplasty (PKP). Methods: Observational case report Case description: A 76-year-old male patient presented with visual impairment in the right eye (OD) 50 years after PKP in 1962 (44 years after PKP also in the left eye (OS) in 1968) following explosion injury. His visual acuity had already been impaired before the trauma because of bilateral corneal opacities. The central corneal thickness of the graft measured 584 µm (OD) and 544 µm (OS), whilst the peripheral host thickness (8 mm zone), however, was 1233 µm (OD, cranial) and 1131 µm (OS, nasal). The original graft diameter measured 6 mm in both eyes and the recipient cornea was cloudy and gray. The endothelial cell count was measured centrally (OD 1162 c/mm2, OS 1320 c/mm2). The visual acuity was 20/100 (OD) and 20/40 (OS). After excimerlaser-assisted repeated PKP (8.0/8.1 mm, OD), the histological analysis of the former graft revealed deposits of acid mucopolysaccharides (AMP) subepithelially, within the interface, in the donor stroma, and in the endothelium, which proved the peripheral recurrence of a macular corneal stromal dystrophy on the graft. Conclusion: Recurrence of macular corneal stromal dystrophy is seldom, but it may occur many decades after PKP. In this patient, the host's stroma was twice as thick as that of the graft. This may be caused by the active production of acid mucopolysaccharides in the host endothelium with secondary endothelial decompensation. Thus, PKP remains the gold standard in the cure of macular corneal dystrophy for long-term visual rehabilitation.
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BACKGROUND AND PURPOSE: With the discrepancy between availability and demand for corneal donors, the purpose of our study was to identify significant factors influencing the suitability and affecting the main reasons for discarding organ-cultured corneas. We thus aimed to minimise the percentage of unsuitable corneas in the long term. PATIENTS AND METHODS: 4140 corneas of 2083 donors were analysed between 2006 and 2016. The factors included age, gender and medical history of the donors as well as storage factors such as post-mortem times. The data was recruited in a Microsoft Access database and evaluated with SPSS 20.0, using logistic regression analyses. In a multiple regression model, six factors influencing the suitability of the donor tissue were analysed. All corneas that did not meet the criteria for elective keratoplasty were considered unsuitable. RESULTS: A high donor age of > 80 years was found to be a significantly negative factor on the suitability of the cornea (p = 0.001) compared to the reference group of donors < 40 years. Previous cataract surgery (p < 0.001) also significantly reduced suitability. Male corneas were significantly less suitable than female corneas (p = 0.028). Hypertension (p = 0.612), chemotherapy (p = 0.745) or diabetes mellitus (p = 0.321) did not significantly affect the suitability. Sepsis (p = 0.026) and multiorgan failure (p < 0.001) as cause of death resulted in significantly higher discarding rates due to contamination of the culture medium. Corneas in which the blood sample collection took more than 12 h from death of the donor had to be discarded significantly more frequently due to a positive donor serology. CONCLUSIONS: Factors such as a history of cataract surgery and high donor age reduced the suitability of corneal donor tissue in organ culture. Diabetes, arterial hypertension and chemotherapy in the donor history did not statistically significantly affect the suitability of donor tissue. Causes of death such as sepsis or multi-organ failure increased the contamination rate of the medium. Post-mortem blood collection after more than 12 h should be avoided due to increased positive serology results.
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Trasplante de Córnea , Leones , Animales , Córnea , Bancos de Ojos , Femenino , Humanos , Masculino , Preservación de Órganos , Donantes de TejidosRESUMEN
BACKGROUND: Since 2016, a designated center for the intravitreal injections (IVI) has been established at the department of ophthalmology. Many aims had supported the project of moving IVIs from the main operations theater. This study aimed to assess the practicality and feasibility of such a move. METHODS: In this IVI center, only patients with macular diseases are treated. The premises are arranged directly next to each other. The standardized treatment process starts with registration. Parallel to the formalities, a refraction test is carried out. If necessary optical coherence tomography (OCT) is carried out and then a full eye examination is performed by a doctor. Afterwards, a specialist/consultant decides on the subsequent treatment strategy. The injection takes place in an adjacent standard designated operating room. Patients are handed the computer-generated discharge letters immediately after the procedure and further appointments are booked on discharge. RESULTS: Despite a 25% increase in the number of IVIs to more than 4000 IVIs per year over the last 2 years, advantages from the establishment of the designated center have resulted as follows: optimal care through precise treatment systems and shorter waiting times. From July to August 2018, 85% of voluntarily participating patients pressed the green or light green smiley face on the "HappyOrNot smiley terminal system". Pressure is taken off the regular outpatient macular consultation service, fixed and direct contact person, pressure is taken off the main operations theater with a significant increase in the diagnosis-related groups (DRG) revenues of 900,000⯠and easily accessible database for statistical and scientific purposes. CONCLUSION: The designated center proved to be an extremely useful and beneficial one-stop center (IVI carrousel) for patients requiring IVI and macular consultations. It significantly released the pressure on both the outpatient department and the outpatient operation center.
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Enfermedades de la Retina , Humanos , Inyecciones Intravítreas , Tomografía de Coherencia Óptica , UniversidadesRESUMEN
PURPOSE: Typically, we observe an unintended hyperopic shift after phototherapeutic keratectomy (PTK). Despite a clear optical axis, elevations of the mid-peripheral cornea often lead to remarkable visual impairment in Salzmann nodular degeneration (SND). The aim of this study was to analyze the effect of mechanical pannus removal and PTK on the corneal curvature in SND. METHODS: Fifteen eyes of 10 patients with visual impairment caused by SND were treated with combined pannus removal and PTK using a masking fluid. Mean age was 53 years. We analyzed best-corrected visual acuity, central corneal power (in diopters, D), spherical equivalent (in D), and irregularity of corneal topography (Index of Surface Variance, Pentacam). RESULTS: Best corrected visual acuity before PTK was 0.64 (median) and improved to 0.85 (median) after the surgical procedure. Mean spherical equivalent was reduced by 1.82 ± 1.4 D from +2.53 D preoperatively to +0.75 D postoperatively (P = 0.001). Mean central corneal power increased by 3.18 ± 3.5 D from 39.8 ± 4.6 D preoperatively to 43 ± 1.7 D postoperatively (P = 0.013). Topographic irregularity normalized from 83.9 ± 53.7 (27-204) to 33.3 ± 14.3 (20-56; Index of Surface Variance) (P = 0.016). CONCLUSIONS: In SND, asymmetric tear film pooling caused by nodules located in the mid-periphery of the cornea may lead to an "optical cornea plana," which results in a marked hyperopic shift accompanied with high irregular astigmatism. Pannus removal combined with excimer laser PTK may restore visual performance, at least in part, because of a myopic shift and regularization of the corneal curvature.