ABSTRACT
Kerathoprosthesis application is limited to strictly definite indications such as: after a severe corneal scald, after repeated graft rejections or temporarily just before the intricate eye operation to expose the posterior segment. Considerable progress in this province has been observed since PMMA were introduced. Recently a new successful method of "champagne cork" kerathoprosthesis, described firstly by Worst, has been reported. It is designed as a reverse cone and in comparison with other models provides significantly wider range of vision and simultaneuosly better visibility of fundus, which are the main advantages of this prosthesis. In our case this pattern of prosthesis was implanted in general anaesthesis and 24 hours after operation the visual acquity was 3/50. The insight into fundus was too blurred to assess fundus details. After 48 hours the haemorrhage to corpus vitreum appeared and after 3 months without clot absorption the decision was made to extract it by pars plana vitrectomy. In local anaesthesis the operation was performed with 3 typical entrance incisions, and clots that formed non-transparent membrane on the cone together with involved corpus vitreum were removed. After 24 hours visual acquity was 5/50 and corpus vitreum and retina could be assessed through an anterior segment. It seems that this type of kerathoprosthesis should be widely recommended.
Subject(s)
Keratitis/surgery , Prostheses and Implants , Prosthesis Implantation/methods , Aged , Dry Eye Syndromes/complications , Female , Humans , Keratitis/etiology , Keratoplasty, Penetrating , Prosthesis Design , Treatment Outcome , Visual AcuityABSTRACT
Lacrimal fluid plays a very significant role in maintaining proper functions of conjuctivas, cornea and eyelids. The fluid is secreted by the main lacrimal gland and additional glands. It produces the so called preocular lacrimal film. A number of clinical tests, such as Chirmer's tests I and II, break-up-time (BUT), lysozyme, and flow tests are used in quantitative and qualitative analyses, as well as in the determination of the lacrimal film stability. The aim of work was to utilize these in assessing the lacrimal secretion and the lacrimal film stability in workers chronically exposed to petroleum derivatives. Fifty three workers from departments of acetobenzene, benzene and butadiene, phenol and acetone, sewage waters, asphalt oxidas, polyethylene and polypropylene, were eligible for the study (group I). During previous examinations, acquired disorders in colour perception were diagnosed in all the subjects by means of the Mansuella-Fansworth 100-Hue test. The age range was 25 to 56 years, with a mediane of 44.1 years +/- 6.5. Mean duration of employment was 22 years (SD +/- 8.25). The control group (group II) was composed of 28 men aged between 24 and 60 years with a median of 42.7 years +/- 6.3, never employed under conditions of exposure to toxic chemicals. On the right eye of each subject Schirmer's test was performed after instilling into the conjunctival sac 1-2 drops of Alcain solution according to Whitcher. Five min following anesthesia of the conjunctival sac, a standardised belt of blotting-paper with colour dampness markers Vidisic (Dr Mann Pharma GMBH, Germany) was placed in the vicinity of the external angle of the eye. After 5 min the degree of the belt dampness was measured in millimetres. After 30 min the break-up-time test was performed on the left eye. Fluorescein was released to conjunctival sac from a sterile belt of blotting-paper (Haag-Strait Co.). A slit lamp with cobalt filter was used to calculate time (in sec) that elapsed between opening of the lid slit and the first symptom of breaking-up the lacrimal film. The results obtained were presented in the form of arithmetic means and standard deviation values +/- SD. Schirmer's test was 13.40 +/- 7.43 mm in group 1, and 22.54 +/- 8.25 mm in the control group, mean values differed significantly, p < 0.01. Lacrimal film break-up-time was 16.30 +/- 6.19 sec in group 1, and 31.48 +/- 7.96 sec in the control group, mean values differed significantly, p < 0.01. In persons chronically exposed to petroleum derivatives, statistically significant decrease in lacrimal secretion, as well as shortening of lacrimal film break-up-time were found when compared with the control group.
