Different suturing techniques variously affect the regularity of postkeratoplasty astigmatism.

OBJECTIVE: This study aimed to determine the effect of various suturing techniques on the regularity of postkeratoplasty astigmatism. DESIGN: A prospective clinical trial. PARTICIPANTS: Sixty-two consecutive patients undergoing penetrating keratoplasty by the same surgeon (MB) participated. INTERVENTION: Each patient was assigned to one of four groups according to the suturing technique used (a = 16 interrupted 10-0 nylon sutures; b = 2 running 10-0 nylon sutures, each with 8 bites; c = 2 running 10-0 nylon sutures, each with 12 bites; d = 2 running 10-0 nylon sutures, each with 16 bites). This was the only parameter permitted to be changed in the standard keratoplasty procedure used for all cases. Corneal topography was performed 1, 3, and 6 months after surgery. The astigmatic patterns seen on the corneal maps then were classified into regular (symmetric or asymmetric bowtie patterns) or irregular (distorted bowtie, multiaxial, or other patterns). MAIN OUTCOME MEASURES: Regularity of postkeratoplasty corneal astigmatism was measured. RESULTS: At all postoperative examination times, the percentage of irregular astigmatic patterns was highest in group a and lowest in group d (chi-square test: P < 0.005). Groups b and c showed intermediate values. The entity of the astigmatic error as measured by the simulated K-readings of the topographic maps did not differ significantly in the four groups. CONCLUSIONS: A suturing technique using 2 running sutures with 16 bites each can minimize irregular postkeratoplasty astigmatism as long as sutures are in place, when compared with interrupted sutures or double-running sutures of less than 16 bites.

[Severe occlusive bilateral retinal vasculitis within the scope of seronegative systemic lupus erythematosus]. / Schwere okklusive Vasculitis retinae beidseits im Rahmen eines seronegativen systemischen Lupus erythematodes.

Retinal vascular manifestation is the most common form of ophthalmic involvement in patients with systemic lupus erythematosus (SLE). Most frequently these consist of cotton-wool spots with or without intraretinal hemorrhages. Although rare, a more severe retinal vaso-occlusive disease, termed retinal vasculitis, has been described. We report on a 37-year-old white female with a 13-year follow-up of chronic discoid lupus erythematosus, which suffered massive bilateral visual loss coincident with the systemic exacerbation of her disease (proteinuria, pneumonia, serositis, leucopenia). The diagnosis of SLE was established with reference to the revised ARA-criteria (American Rheumatism Association). Ophthalmoscopy and fluorescein angiography revealed the typical aspect of a SLE-associated vaso-occlusive retinopathy on both eyes with marked ischemia of the macula. Immediate maximal immuno-suppressive therapy, early performed panretinal photocoagulation and subsequent cryoretinopexy did not stop the progression of the disease. Six months after the initial event vascularisations of the disc and rubeosis iridis occurred, but no secondary glaucoma up to date. In this patient, the almost complete absence of characteristic autoantibodies and immunological markers was striking. The correlation with other lupus manifestations, different therapeutic concepts and prognostic factors in SLE-associated retinal vasculitis are discussed.

[Ultrasonic diagnosis prior to vitrectomy. Critical evaluation of 51 cases]. / Ultraschalldiagnostik vor Vitrektomie. Kritische Auswertung von 51 Fällen.

In ophthalmology it is of increasing importance to assess intraocular pathology prior to vitroretinal surgery by means of B- and A-mode ultrasound. Even for the experienced examiner with advanced instrumentation, major problems can arise as to whether retinal detachment has developed or not. This task involves the ability for acoustical differentiation of thin tissue membranes. The authors compared preoperative ultrasonic results obtained in 51 cases with the surgical findings during vitrectomy. The presence or absence of retinal detachment was evaluated correctly in 33 cases (91.7%) using high resolution contact B-mode alone. In difficult cases maximal echo amplitudes reflected from the suspected membranes were evaluated using a hand-held A-mode transducer (level difference A-mode echography) in addition to contact B-mode. Even the combined technique, though helpful in most cases, could not detect the presence or absence of retinal detachment in all cases.