Scheimpflug Camera and Swept-Source Optical Coherence Tomography in Pachymetry Evaluation of Diabetic Patients.

AIM: The comparative analysis of the central and peripheral corneal thicknesses using two different imaging systems: Scheimpflug camera and swept-source OCT was performed to investigate the differences in corneal thickness analysis in diabetic patients. MATERIALS AND METHODS: The study group consisted of the 147 eyes of 107 diabetic patients who were examined and compared with 138 eyes of 89 nondiabetic cataract patients. The inclusion criteria for the study group was diabetes mellitus type II identified no less than 10 years ago, with NPDR not requiring prior laser treatment. The control group was recruited from nondiabetic patients. Measurements were obtained on the Pentacam Scheimpflug imaging system and Casia swept-source OCT. All study parameters from anterior chamber images were processed for five different zones, the central zone and four peripherals-superior, inferior, nasal, and temporal. A fit zone diameter of 4 mm was applied for both instruments. RESULTS: The Pentacam system overestimated corneal measurements in the DM group when compared with the Casia OCT in superior corneal zone (p=0.04), inferior corneal zone (p=0.02), nasal corneal zone (p < 0.001), and temporal corneal zone (p=0.01). In the control group, there were also statistically significant differences between the Pentacam and Casia OCT measured values in inferior corneal zone (p=0.001), nasal corneal zone (p=0.04), and temporal corneal zone (p < 0.001). CONCLUSION: Scheimpflug camera pachymetry measurements showed statistically higher CCT values when compared with swept-source OCT measurements.

Total Penetrating Keratoplasty: Indications, Therapeutic Approach, and Long-Term Follow-Up.

PURPOSE: Evaluation of the indications, anatomical and functional results, and complications of total penetrating keratoplasty (TPK) in disorders involving whole cornea. MATERIALS AND METHODS: We analyzed outcomes of the surgical treatment of 47 eyes of 46 patients that underwent TPK. Indications were infectious keratitis, autoimmune disease, injury of the eyeball (mainly chemical burns), and other combined disorders. The surgical technique involved dissection of affected tissues with a margin of 1.0 mm. The size of the corneal graft ranged from 10.0 to 14.0 mm. We analyzed indications, outcomes, and complications of surgery. RESULTS: Final restoration of the ocular integrity and maintenance of the globe were achieved in 27 eyes (57%). More than one surgery was necessary in a total of 29 eyes (62%). The frequency of retransplantations did not vary significantly between the groups with different causes of corneal melting/perforation (63% of eyes with infection, 66% of eyes after trauma and 70% of eyes of patients with autoimmune disorders). Surgical treatment failed in 20 eyes (43%). Evisceration was necessary in 13 eyes (28%), phthisis occurred in 7 cases (15%). CONCLUSION: TPK should be considered as a last line treatment in huge corneal destruction to restore integrity of the eye globe.

Measurements of Corneal Thickness in Eyes with Pseudoexfoliation Syndrome: Comparative Study of Different Image Processing Protocols.

PURPOSE: Comparative analysis of central and peripheral corneal thickness in PEX patients using three different imaging systems: Pentacam-Scheimpflug device, time-domain optical coherence tomography (OCT) Visante, and swept-source OCT Casia. MATERIALS AND METHODS: 128 eyes of 80 patients with diagnosed PEX were examined and compared with 112 normal, non-PEX eyes of 72 cataract patients. The study parameters included 5 measured zones: central and 4 peripheral (superior, inferior, nasal, and temporal). RESULTS: The mean CCT in eyes with PEX syndrome measured with all three instruments was thicker than that in normal eyes. Corneal thickness measurements in the PEX group were statistically significantly different between Pentacam and OCT Casia: central corneal thickness (p = 0.04), inferior corneal zone (p = 0.01), and nasal and temporal corneal zones (p < 0.01). Between Pentacam and OCT Visante inferior, nasal and temporal corneal zones were statistically significantly different (p < 0.01). Between OCT Casia and OCT Visante, there were no statistically significant differences in measured parameters values. CONCLUSION: The central corneal thickness in eyes with PEX syndrome measured with three different independent methods is higher than that in the non-PEX group, and despite variable peripheral corneal thickness, this one parameter is still crucial in intraocular pressure measurements.

Differences in Surgical Management of Corneal Perforations, Measured over Six Years.

Purpose. To report the surgical approach, anatomical and functional results, and complications in the group of patients with corneal perforation. Materials and Methods. 247 eyes with corneal perforation were operated on between January 2010 and July 2016. The three surgical procedures, dependent on size and location of perforation, were performed: full-sized penetrating keratoplasty, corneoscleral patch graft, and anterior lamellar keratoplasty. The eyes underwent the minimum 6-month follow-up visit. Results. Between January 2010 and July 2016, 247 surgeries were performed: 116 penetrating keratoplasties, 117 corneoscleral patch grafts, and 14 anterior lamellar keratoplasties. More than one procedure was necessary in 32 eyes. Final improvement of the visual acuity, within a gain of 2 or more lines with the Snellen test, was achieved in 56 operated eyes. To achieve better final visual acuity, 75 eyes required successive surgical treatment. Complications of the surgery comprised persistent epithelial defect, glaucoma or ocular hypertension, corneal oedema, graft melting, loose corneal sutures, reinfection, anterior synechiae and fibrinoid membranes, and endophthalmitis. In 26 eyes, the treatment failure was reported. Conclusions. There is no one general-purpose surgical technique to treat corneal perforations. The complex nature of this pathology remains the individual, careful but also very distinct and multifactorial approach.

Cultivated Oral Mucosa Epithelium in Ocular Surface Reconstruction in Aniridia Patients.

PURPOSE: Efficacy of cultivated oral mucosa epithelial transplantation (COMET) procedure in corneal epithelium restoration of aniridia patients. METHODS: Study subjects were aniridia patients (13 patients; 17 eyes) with irregular, vascular conjunctival pannus involving visual axis who underwent autologous transplantation of cultivated epithelium. For the procedure oral mucosa epithelial cells were obtained from buccal mucosa with further enzymatic treatment. Suspension of single cells was seeded on previously prepared denuded amniotic membrane. Cultures were carried on culture dishes inserts in the presence of the inactivated with Mitomycin C monolayer of 3T3 fibroblasts. Cultures were carried for seven days. Stratified oral mucosa epithelium with its amniotic membrane carrier was transplanted on the surgically denuded corneal surface of aniridia patients with total or subtotal limbal stem cell deficiency. Outcome Measures. Corneal surface, epithelial regularity, and visual acuity improvement were evaluated. RESULTS: At the end of the observation period, 76.4% of the eyes had regular transparent epithelium and 23.5% had developed epithelial defects or central corneal haze; in 88.2% of cases visual acuity had increased. VA range was from HM 0.05 before the surgery to HM up to 0.1 after surgery. CONCLUSION: Application of cultivated oral mucosa epithelium restores regular epithelium on the corneal surface with moderate improvement in quality of vision.

[Culture of the corneal epithelium--comparison of the mitotic potential of limbal cells from living and cadaveric donors]. / Hodowla nablonka rogówki--porównanie potencjalu mitotycznego komórek uzyskanych od dawców zywych i po smierci.

PURPOSE: We analyse effectiveness of corneal limbal cells' culture prepared from heart-beating organ donors, that include living donors and from cadaver donors buttons following 3 days storage in 4 degrees C in Likorol. MATERIAL AND METHODS: For experiment 12 adults (living and heart-beating organ donors) aged 28-63 (mean 46.3) and 12 corneal buttons of cadaver (aged 18-51, mean 34.1) were qualified. Tissue samples (1 mm2) were taken from superior corneal limbus. Sample from living donor obtained during routine operation was sent immediately to laboratory, as well as from heart-beating organ donor. The limbal biopsy of preserved cornea was taken after 3 days storage in 4 degrees C (Likorol). Samples were treated with trypsin/EDTA solution before culture. Collected cells in similar density in 1 ml of medium laid on dishes inserts, covered with fibrin (Tissucol) and cultured in presence of feeder layer of fibroblasts (L929 line). Epithelial cells were cultured for 14 days at 37 degrees C in humidified 5% CO2 atmosphere in supplemented 2:1 mixture of DMEM and Ham's F12. On the 14th day cells were collected. Number of cells per 1 ml of medium was counted by cytometer. Immunostaining for epithelium type (Keratin 3) was performed. RESULTS: The number of cells obtained from cadaver donors reached 184.2+/-14.9% whereas from living donors revealed 1013.1+/-104.2%, increase in relation to number of delivered cells. We observed only 0.83+/-0.3 colonies per microscopic area in cultures from preserved tissue versus 6.67+/-0.6 colonies in cultures from living donor. CONCLUSIONS: The preservation in 4 degrees C in Likorol significantly decreases proliferative potential of the corneal limbus.