Robotic Stereotactic Radiotherapy for Intracranial Meningiomas-An Opportunity for Radiation Dose De-Escalation.

OBJECTIVE: To evaluate the possibility of dose de-escalation, with consideration of the efficacy and safety of robotic stereotactic CyberKnife radiotherapy in patients diagnosed with intracranial meningiomas. METHODS: The study group consisted of 172 patients (42 men and 130 women) treated in III Radiotherapy and Chemotherapy Clinic of Maria Sklodowska-Curie National Research Institute of Oncology in Gliwice between January 2011 and July 2018. The qualification for dose de-escalation was based on MRI (magnetic resonance imaging) features: largest tumor diameter less than 5 cm, well-defined tumor margins, no edema, and no brain infiltration. The age of patients was 21-79 years (median 59 years) at diagnosis and 24-80 years (median 62 years) at radiotherapy. Sixty-seven patients (Group A) were irradiated after initial surgery. Histopathological findings were meningioma grade WHO 1 in 51 and WHO 2 in 16 cases. Group B (105 patients) had no prior surgery and the diagnosis was based on the typical features of meningioma on MRI. All patients qualified for the robotic stereotactic CyberKnife radiotherapy, and the total dose received was 18 Gy in three fractions to reference isodose 78-92%. RESULTS: Follow-up period was 18 to 124 months (median 67.5 months). Five- and eight-year progression free survival was 90.3% and 89.4%, respectively. Two patients died during the follow-up period. Progression of tumor after radiotherapy was registered in 16 cases. Four patients required surgery due to progressive disease, and three of them were progression free during further follow-up. Twelve patients received a second course of robotic radiotherapy, 11 of them had stable disease, and one patient showed further tumor growth but died of heart failure. Crude progression free survival after both primary and secondary treatment was 98.8%. Radiotherapy was well-tolerated: acute toxicity grade 1/2 (EORTC-RTOG scale) was seen in 10.5% of patients. We did not observe any late effects of radiotherapy. CONCLUSION: Stereotactic CyberKnife radiotherapy with total dose of 18 Gy delivered in three fractions showed comparable efficacy to treatment schedules with higher doses. This could support the idea of dose de-escalation in the treatment of intracranial meningiomas.

Long-Term Clinical Outcomes of Ahmed Valve Implantation in Aniridic Glaucoma.

BACKGROUND: This study assessed the efficacy and safety of Ahmed valve implantation in patients with aniridic glaucoma for three consecutive years. METHODS: Six adult patients (seven eyes) with Ahmed valve (AV) implants for aniridic glaucoma were enrolled in the study. The primary outcome measures were intraocular pressure reduction, glaucoma medication use, success rates, and visual acuity after AV implantation. A 30% reduction in IOP from baseline without the need for re-intervention was considered an effective treatment. The cessation of antiglaucoma medications was defined as complete success. Intraoperative and postoperative complications were included as secondary outcome measures. Measurements were performed preoperatively, at the first week, and 1, 3, 6, 12, 18, 24, 30, and 36 months postoperatively. RESULTS: A total of seven eyes (6 patients) were evaluated 36 months after AV implantation. The mean ± SD values of IOP preoperatively at 1 day, 1 week, and 1, 3, 6, 12, 18, 24, 30, and 36 months postoperatively were 30.4 ± 4.0 mmHg, 14.6 ± 4.6 mmHg, 16.1 ± 4.6 mmHg, 20.7 ± 7.0 mmHg, 14.5 ± 2.7 mmHg, 16.5 ± 5.9 mmHg, 16.2 ± 4.0 mmHg, 16.3 ± 4.3 mmHg, 17.2 ± 10.1 mmHg, 17.6 ± 6.9 mmHg, and 18.2 ± 5.5 mmHg, respectively. At the last follow up, the mean IOP was reduced by 40.2%. The qualified success rate was 85.7%. One patient (one eye) at the last follow-up visit did not require antiglaucoma medications, resulting in a complete success rate of 14.3%. Intra- and postoperative mild or moderate subconjunctival bleeding was observed in all the patients. No other major/minor intraoperative or postoperative complications were noted. CONCLUSIONS: In long-term follow up, the AV implantation procedure is well-tolerated and relatively safe for reducing IOP in adult aniridia patients with glaucoma. These results should be validated through studies involving a larger patient cohort.

The Impact of Robotic Fractionated Radiotherapy for Benign Tumors of Parasellar Region on the Eye Structure and Function.

PURPOSE: To evaluate the radiation effect of fractionated robotic radiotherapy of benign tumors located in the parasellar region on the anterior and posterior segments of the eye. METHODS: A prospective observational study based on the expanded ophthalmological examination. The pre-treatment baseline was used as a control for the post-radiotherapy follow-up examinations. The study group consists of 34 patients (68 eyes) irradiated using the CyberKnife system. There were ten patients with cavernous sinus meningioma, nine with pituitary adenoma, five with meningioma of the anterior and middle cranial fossa, five with meningioma in the region close to optic chiasm, three with craniopharyngioma, and two with meningioma of the orbit. All patients were treated using three fractions of 600-800 cGy. We assessed the impact of radiation on the eye based on changes in anatomical and functional features. The condition of the eye surface, central corneal thickness (CCT), endothelial cell density (ECD), lens densitometry, central macular thickness (CMT), and retinal nerve fiber layer (RNFL) were the anatomical features assessed. The functional tests were best-corrected visual acuity (BCVA), intraocular pressure (IOP), visual field (VF) and visual-evoked potentials (VEP). An ophthalmologic examination was performed before and 6, 12, 18, and 24 months after radiotherapy. RESULTS: We did not observe any significant changes in BCVA, IOP, CCT, CMT, VF, and VEP, nor in the slit-lamp examination during the two-years observation. We found a significant decrease in ECD at all follow-up measurements. The drop in ECD exceeded approximated age-related physiological loss. The reduction in ECD was not large enough to disrupt corneal function and thus affect vision. We also observed a statistically significant reduction of RNFL in all observation time points. However, there was no correlation between the dose delivered to the optic pathway and the decrease in RNFL thickness. The thinning of the RNFL was not significant enough to impair visual function. CONCLUSION: Fractionated robotic radiotherapy of the tumors located close to the optical pathway is safe and does not impair patient's vision. Minor changes found in optic nerve anatomy (RNFL thinning) might be related to radiation effect or tumor compression. The causal relation between low doses of radiation delivered to the cornea and the observed significant but slight decrease in ECD is uncertain. The observed changes did not cause visual disturbances perceivable by the patients.

The use of infrared thermal imaging in tonometry with a Scheimpflug camera.

Infrared thermal imaging is currently used in almost every field of medicine. This paper presents the novel use of thermography in ophthalmology - using a thermal camera to assess correct intraocular pressure measurement depending on the position of the patient's head during non-contact tonometry. For the analysed group of 10 healthy subjects, thermographic images of the face were recorded before and after intraocular pressure testing. Pressure was tested with a non-contact tonometer with a Scheimpflug camera. For the acquired 20: 2D images (thermograms), an analysis of the characteristic areas of the face determined temperature changes of the patient's face in contact with the tonometer frame. Analysis and processing of the acquired thermograms was carried out in MATLAB® with the Image Processing Toolbox. The results clearly showed a decrease in the patient's face temperature where the face was in contact with tonometer supports. Temperature changes in the patient's face provide valuable information about the correct position of their head in the device, which directly translates into measurement quality. Therefore, the analysis of changes in the patient's face temperature both before and after the examination can be a tool for assessing correct patient positioning in the tonometer supports.

Physicochemical Analysis of Sediments Formed on the Surface of Hydrophilic Intraocular Lens after Descemet's Stripping Endothelial Keratoplasty.

An intraocular lens (IOL) is a synthetic, artificial lens placed inside the eye that replaces a natural lens that is surgically removed, usually as part of cataract surgery. The opacification of the artificial lens can be related to the formation of the sediments on its surface and could seriously impair vision. The physicochemical analysis was performed on an explanted hydrophilic IOL and compared to the unused one, considered as a reference IOL. The studies were carried out using surface sensitive techniques, which can contribute to a better understanding of the sedimentation process on hydrophilic IOLs' surfaces. The microscopic studies allowed us to determine the morphology of sediments observed on explanted IOL. The photoelectron spectroscopy measurements revealed the presence of organic and inorganic compounds at the lens surface. Mass spectroscopy measurements confirmed the chemical composition of deposits and allowed for chemical imaging of the IOL surface. Applied techniques allowed to obtain a new set of information approximating the origin of the sediments' formation on the surface of the hydrophilic IOLs after Descemet's stripping endothelial keratoplasty.

Metabolomic Signature Discriminates Normal Human Cornea from Keratoconus-A Pilot GC/MS Study.

The molecular etiology of keratoconus (KC), a pathological condition of the human cornea, remains unclear. The aim of this work was to perform profiling of metabolites and identification of features discriminating this pathology from the normal cornea. The combination of gas chromatography and mass spectrometry (GC/MS) techniques has been applied for profiling and identification of metabolites in corneal buttons from 6 healthy controls and 7 KC patients. An untargeted GC/MS-based approach allowed the detection of 377 compounds, including 46 identified unique metabolites, whose levels enabled the separation of compared groups of samples in unsupervised hierarchical cluster analysis. There were 13 identified metabolites whose levels differentiated between groups of samples. Downregulation of several carboxylic acids, fatty acids, and steroids was observed in KC when compared to the normal cornea. Metabolic pathways associated with compounds that discriminated both groups were involved in energy production, lipid metabolism, and amino acid metabolism. An observed signature may reflect cellular processes involved in the development of KC pathology, including oxidative stress and inflammation.

Long-Term Outcomes of Allogeneic Ocular Surface Reconstruction: Keratolimbal Allograft (KLAL) Followed by Penetrating Keratoplasty (PK).

PURPOSE: Long-term results of the patients with total LSCD, who had undergone keratolimbal allograft (KLAL) for limbal reconstruction followed by penetrating keratoplasty (PK). METHODS: The study analyzes surgical treatment of 43 eyes with severe ocular surface disorders. All subjects underwent KLAL to achieve suitable conditions for consecutive PK. Due to failures of primary treatment in 17 eyes (39%), the KLAL was repeated. PK was performed in all the patients at 9-12 months after KLAL. As a retrospective study we analyzed data from the medical records including the preoperative and postoperative best corrected visual acuity, corneal clarity, surgical outcomes and complications, postoperative intraocular pressure, graft rejection, and other comorbidities and complications. RESULTS: The preoperative visual acuity ranged from light perception to 0.01. The final improvement of visual acuity within a gain of one or more lines with the Snellen chart, including the results of successive surgical treatments after PK, was achieved in 23 operated eyes (53%). Early graft rejection was observed in 4 eyes (9%). In 3 eyes, it was manifested as endothelial rejection, and in 1 eye, as combined endothelial and epithelial rejection. PK failure requiring repetitive PK was present in 14 eyes (32%). Phthisis bulbi developed in 6 eyes (14%). Glaucoma or ocular hypertension was reported in 25 eyes (58%). A majority were treated with up to 3 topical agents or referred for trabeculectomy in 3 cases, transscleral cyclophotocoagulation in 2 eyes, and EX-PRESS glaucoma shunt implantation in 3 cases. CONCLUSIONS: Successful KLAL carries a high risk of subsequent PK failure. Visual function remains the second aim of treatment; the primary one is to stabilize the surface.

Endogenous fluorescence can differentiate the keratoconic cornea.

The purpose of the study was to investigate the endogenous fluorescence of the keratoconic cornea in order to analyze changes in the spectra due to the keratoconic stroma abnormalities. Twenty-two corneal buttons obtained from patients with keratoconus (KC, N = 22) at the time of penetrating keratoplasty were used. As a reference, twelve normal corneas (N = 12): ten from the Eye Bank and two from enucleated eyes due to choroidal melanoma were used. The fluorescence excitation/emission matrices (EEM) in the ranges of 250-400/260-600 nm were recorded. Healthy cornea, keratoconic cornea and sclera showed three main EEM bands, which correspond to the following fluorophores: tryptophan residues in the proteoglycan fraction of corneal/scleral stromas, naturally occurring collagen cross-links and the NAD(P)H fraction present in the metabolically active cells. Relative intensity factors S1, S2 and S3 describing the contribution of each kind of fluorophore to the total fluorescence of the tissue were calculated. Normal and keratoconic corneas show qualitatively similar fluorescence matrices, but the statistically significant differences in the mean values of the S1, S2 and S3 parameters for the KC and normal corneas were observed indicating changes in contribution of different fluorophores to the whole fluorescence of the tissue. Moreover, differences between multidimensional distribution of the relative intensity factors S1, S2 and S3 between these groups were demonstrated (p < 0.001). In conclusions: Differences in the relative intensity factors calculated on a basis of the fluorescence spectra can correspond to the changes found in the KC stroma regarding natural collagen cross-links and the proteoglycan fraction. These parameters well differentiate the KC and normal corneas that could serve as an additional tool for the keratoconus characterization.

Cytoarchitecture of epithelial inflammatory infiltration indicates the aetiology of infectious keratitis.

PURPOSE: To analyse cytological features of corneal epithelium in infectious keratitis. METHODS: One hundred and eighteen patients (53 males and 65 females) diagnosed with acute stage of infectious keratitis (45 viral, 40 bacterial, 23 fungal, 10 Acanthamoeba keratitis) were included in study. We performed retrospective analysis of bright and blue-light slit-lamp photographs and in vivo corneal confocal microscopy scans of the corneal epithelium from five corneal regions (superior, inferior, temporal, nasal and central). Density, morphology of inflammatory cells and their relation to epithelial structures, as well as density of nerve fibres, were evaluated in relation to the keratitis aetiology. RESULTS: We characterized five morphological types of inflammatory cells forming infiltration. Cell and nerve fibre densities showed significant differences between groups, and the most intense inflammatory infiltration was associated with fungal then bacterial, viral and Acanthamoeba keratitis. Additionally, differences in aetiology-specific ratio of round/non-round inflammatory cells were observed. CONCLUSION: Confocal microscopy analysis in infectious keratitis of various aetiologies revealed quantitative and qualitative differences in inflammatory cell infiltration expressed in different ratio of round/non-round inflammatory cells. In vivo microscopic analysis of both the corneal epithelial layer cytopathology and the cytology of inflammatory infiltration provides a fast and specific differentiation of keratitis aetiology that may increase the accuracy in the selection of the initial treatment.

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.

Atypical regressive corneal endothelial cysts in long-term confocal follow-up: a case report.

Corneal 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 patient's 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.

[Ocular symptoms in rheumatic diseases]. / Objawy oczne w wybranych chorobach reumatycznych.

Rheumatic diseases are frequently associated with eye disorders presenting with a wide range of signs and symptoms. Dry eye syndrome, keratitis, uveitis, scleritis and retinal vasculitis are often diagnosed in patients with rheumatic diseases. It is important not to overlook even subtle signs of ocular involvement as it may result in serious complications. Moreover in some cases ocular manifestation may help in proper diagnosis of systemic condition or indicate necessity of intensified treatment of underlying condition. Appropriate treatment of rheumatic diseases require careful follow up and involvement of various specialists including ophthalmologists as well as patient education.

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.

[Meibomian gland dysfunction--review]. / Dysfunkcja gruczolów Meiboma--przeglad pismiennictwa.

Meibomian gland dysfunction is a common ocular disorder affecting from 39 to 50% of population. Despite that, so far a pathophysiology path of the disease remains unknown, moreover there is no distinct border between physiology and the disease. There has been no clear diagnostic criteria. The purpose of this review was to combine a current knowledge of Meibomian gland anatomy, Meibomian gland dysfunction epidemiology, as well as presenting current definition, nomenclature, classification and diagnostic criteria. The importance of diagnosis associated with conditions such as aqueous tear deficiency, seborrheic dermatitis, and rosacea is emphasized. The available treatment methods are discussed. Meibomian gland dysfunction, blepharitis, dry eye syndrome.

[Assessment of retinal thickness obtain by optical coherence tomography after Nd: YAG capsulotomy]. / Ocena grubosci siatkówki na podstawie badania optycznej koherentnej tomografii po wykonaniu Nd: YAG kapsulotomii.

PURPOSE: To measure central macular thickness change after Nd: YAG capsulotomy using optical coherence tomography (OCT). MATERIAL AND METHODS: 55 patients (43 females and 12 males), mean age 65.1 +/- 13.9 years (range 21-87) who underwent Nd: YAG capsulotomy for posterior capsule opacification. Patients were examined preoperatively and one day, one week, one month, three months and six months after Nd: YAG capsulotomy. Central retinal thickness was measured by Stratus IV OCT Optical Coherence Tomography from Carl Zeiss Meditec, Inc. using "fast macular thickness" map protocol. All patients underwent ophthalmic examination including best-corrected visual acuity, fundus examination and intraocular pressure measurement. RESULTS: The initial median and range of the central retinal thickness was 212 microm (168-228), after one day 207 microm (168-232), after one week 207 microm (166-241), after one month 207 microm (163-252), after 3 months 207 microm (171-242), and 210 microm (170-235) 6 months after treatment. Proportional changes of the central retinal thickness was after one day -0.5 (-13.3 to 5.6), after one week 0.5 (-11.6 to 8.1), after one month -0.4 (-8.3 to 14.5), after 3 months 0.5 (-8.7 to 10.0) and 6 months after capsulotomy 0.5 (-5.8 to 7.7). There was no statistically significant change of the central macular thickness in any time point. Cystoid macular edema was observed in three patients 9.0 and 14 weeks after treatment. No other complications were noticed. CONCLUSIONS: Laser capsulotomy should be considered as a safe procedure for the macula. Optical coherence tomography is a useful diagnostic method that can be used in qualification and monitoring of patients undergoing Nd: YAG capsulotomy.

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 microm preoperatively. On postoperative Day 1, mean CCT was 816 microm and GT was 191 microm. 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 recipient's part of cornea. The most rapid rate of thickness decrease was observed between 1 week and 1 month: 5.34 microm/day for the entire cornea and 2.54 microm/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.

[Descemet stripping endothelial keratoplasty using Busin technique to minimize endothelial cell loss]. / Technika oszczedzajaca endotelium platka rogówki w przeszczepie tylnym za pomoca rynny zeslizgowej busina.

PURPOSE: To present the results of endothelial keratoplasty (DSEK) using "Busin" technique performed from September 2008 to December 2008 in Ophthalmology Department, District Railway Hospital in Katowice. MATERIAL AND METHODS: 7 patients (7 eyes) underwent DSEK using "Busin glide" technique, due to the corneal edema after cataract phacoemulsification. Best corrected visual acuity, central corneal thickness, endothelium cell density were assessed three and six month postoperatively. RESULTS: Mean time period between cataract surgery to DSEK was 15.8 month (from 11 to 37 months). The mean central corneal thickness before surgery was 750 microm (from 690 microm to 850 microm), mean best corrected visual acuity 0.001 (from light perception to 0.01). The average best corrected visual acuity three months after surgery was 0.4 (0.1 to 0.6), and 0.5 (from 0.1 to 0.7), six months. Mean central corneal thickness 3 months postoperatively equaled 790 microm (from 714 microm to 850 microm), and a sixth month was 659 microm (from 800 microm to 604 microm). Three months after DSEK, mean endothelium cell density was 2640/mm2 (from 2301/mm2 to 2904/mm2), six months after DSEK the average endothelial cell density equaled 2430/mm2 (from 2210/mm2 to 2780/mm2). Disc dislocation was not observed in studied group. CONCLUSIONS: The use of BG as a donor lenticule insertion technique in DSEK technique seems to be a safe support of this lamellar surgery.

[Results of anterior lamellar keratoplasty performed with "big bubble" technique]. / Wyniki keratoplastyki glebokiej przedniej metoda "big bubble".

PURPOSE: To present the results of deep anterior lamellar keratoplasty (DALK) using "big bubble" technique, performed from 2006 to 2008 in Ophthalmology Department, District Railway Hospital in Katowice. MATERIAL AND METHODS: 53 patients (53 eyes) underwent DALK using "big bubble" technique due to keratoconus, corneal dystrophies and postinflammatory corneal opacification with continue Descemet's membrane and healthy endothelium. Best corrected visual acuity, main astigmatism, central corneal thickness, endothelium cell density, intra- and postoperative complications were assessed. RESULTS: Mean follow up 15.4 months ranged from 11 to 24 months. Averaged best corrected visual acuity averaged equaled 0.6 and ranged from 0.1 to 4.0, mean astigmatism 2.6 D, ranged from 1.0 D to 2.6 D. Mean central corneal thickness was 503.4 microm and ranged from 379 microm to 694 microm, mean endothelium cell density before surgery equaled 2895/ mm2 and postoperatively 2398/ mm2. Incomplete Descemet's membrane detachment was diagnosed in 3 cases, intraoperative microperforations in 5 eyes and conversion to penetrating keratoplasty was needed in 4 patients. Postoperative disc opacity in 3 cases, increase of intraocular preassures in 1 case and early postoperative Descemet's membrane detachment in 1 eye. Posterior cataract formation in 4 eyes and in 1 case permanent mydriasis (Urrets-Zavalia Syndrome), was observed. There was no graft rejection observed. CONCLUSIONS: Although technically more demanding lamellar keratoplasty, could be considered as an alternative "gold standard" penetrating keratoplasty.

Anterior segment optical coherence tomography in eye injuries.

BACKGROUND: To evaluate the usefulness of anterior segment optical coherence tomography (AS OCT) for initial diagnosis and for monitoring treatment results in eye injury cases. METHODS: We 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. RESULTS: Slit-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. CONCLUSIONS: AS OCT is a very valuable tool in ophthalmic departments dealing with ocular trauma, for early diagnosis and for monitoring treatment progress.

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 microm preoperatively and 0.605 microm postoperatively. The mean ECD was 3198 cells/mm(2) in donor lenticules and 2048 cells/mm(2) 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.