Deep Sclerectomy with Nonabsorbable Implant (T-Flux) in Patients with Pseudoexfoliation Glaucoma.

Purpose. To evaluate the effectiveness of deep sclerectomy with T-flux implant (DS T-flux) in patients with pseudoexfoliation glaucoma (PExG). Methods. 20 eyes of 18 patients with medically uncontrolled PExG have undergone DS T-flux implantation. Postoperatively we evaluated the IOP values and the frequency of complications. The minimum follow-up time was 12 months (20 eyes) and the maximum 24 months (10 eyes). Results. The mean preoperative IOP was 36.8 ± 8.7 mmHg. The IOP significantly decreased throughout all postoperative periods (P < 0.05) and reached 1 day after surgery 11.45 ± 6.6 mmHg; 3 months 13.45 ± 3.6 mmHg; 12 months 14 ± 2.8 mmHg; and 24 months 14.80 ± 2.4 mmHg. Complete success rate, defined as IOP ≤ 18 mmHg without medication, was 85% (17/20 eyes) at 12 months. Qualified success rate, defined as IOP ≤ 18 mmHg with or without medication, was 100% (20/20 eyes). The most frequent postoperative complications were mild hyphaema (9 patients, 45%), choroidal detachment (3 patients, 15%), and hypotony-IOP < 5 mmHg (2 patients, 10%). Conclusions. DS with T-flux implant is a safe and effective surgical treatment method for medically uncontrolled PExG. The number of complications is low.

Use of PocketMaker Microkeratome for Creation of Corneal Pocket for Foldable Keratoprosthesis KeraKlear Implantation - Case Series.

PURPOSE: To describe a surgical method for corneal pocket creation for KeraKlear keratoprosthesis implantation by PocketMaker microkeratome. METHODS: We implanted keratoprosthesis KeraKlear in 3 patients. In all cases, we used a microkeratome PocketMaker to create a corneal pocket, where the incision was made at a depth of 300 µm with a vibrating diamond blade. RESULTS: Although corneas have been extensively opaque and vascularized, in all three cases we successfully performed suction of the microkeratome system and created a corneal pocket without any difficulties. Subsequent keratoprosthesis implantations were performed without any problems. CONCLUSION: The technique is simple, relatively cheap, and the creation of the corneal pocket is possible even in patients with vascularized and opaque cornea.

Safety of hydroimplantation: a foldable intraocular lens implantation without the use of an ophthalmic viscosurgical device.

PURPOSE: To compare the safety of a single-piece, foldable intraocular lens (IOL) hydroimplantation with that of a standard implantation using an ophthalmic viscosurgical device (OVD). METHODS: One hundred consecutive patients with bilateral age-related cataract surgery were enrolled into a prospective double-blind study. Each patient's first eye was randomly assigned to a standard implantation technique with an OVD or the hydroimplantation technique, while the fellow eye received the opposite technique. The main outcomes measured were endothelial cell loss, postoperative changes of intraocular pressure (IOP), and the frequency of complications. RESULTS: The reduction of endothelial cell density 1 month and 6 months after the surgery was 9.76% ± 13.5%, 10.7% ± 12.6%, respectively, in group A (OVD) and 9.07% ± 12.7%, 9.13% ± 13.7%, respectively, in group B (hydroimplantation). The differences were not statistically significant. The mean IOP 2 hours after surgery was 10.19 ± 6.78 mm Hg in group A and 9.92 ± 7.01 mm Hg in group B. Twenty-four hours and 1 month after surgery, the mean IOP was 14.52 ± 5.59 mm Hg and 13.21 ± 3.5 mm Hg, respectively, in group A, and 15.45 ± 5.77 mm Hg and 13.1 ± 3.44 mm Hg, respectively, in group B. The differences between groups A and B were not statistically significant. CONCLUSIONS: The hydroimplantation technique is a safe technique for single-piece foldable IOL implantation. There was no increase in intraoperative and postoperative complications compared with the standard implantation technique using an OVD.

Hybrid Technique of Lamellar Keratoplasty (DMEK-S).

PURPOSE: To evaluate the outcomes of the hybrid technique of posterior lamellar keratoplasty (DMEK-S). MATERIALS AND METHODS: 71 eyes of 55 patients enrolled in a single-center study underwent posterior lamellar keratoplasty with a hybrid lamella DMEK-S implanted using a solution implantation technique, owing to endothelial dysfunction. The outcome measures studied were visual acuity and endothelial cell density. RESULTS: The rate of endothelial cell loss caused by surgery was 43.8%. During followups, we observed the stabilization of postoperative findings, or at minimum a very low rate of corneal endothelial cell loss. The UCDVA and BCDVA dramatically improved postoperatively. The rebubbling rate in our group of patients was 61.9%. We replaced the lamella due to its failure or malfunction in 17 patients (23.9%). CONCLUSION: In summary, DMEK-S combines the advantages of DSEK/DSAEK and DMEK. The central zone of bare Descemet's membrane and endothelium allows for very good visual outcomes, and the peripheral rim allows for better manipulation of the lamella during implantation. It is an effective method of treating the endothelial dysfunction of various etiologies, but the high complication rate needs to be addressed before widespread implementation of the technique in the future.

Descemet membrane endothelial keratoplasty with a stromal rim in the treatment of posterior polymorphous corneal dystrophy.

A 20-year-old patient, diagnosed with posterior polymorphous corneal dystrophy, developed corneal edema for which he underwent Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) in the right eye. No intra- or postoperative complications were noted. At the last follow-up 2 years and 9 months after the procedure, the best corrected visual acuity was 1.0 and endothelial cell density declined from 3533 cells/mm 2 to 1012 cells/mm 2 . Despite the endothelial cell loss, DMEK-S appears to be a good alternative to other surgical techniques for the treatment of corneal endotheliopathies, and it may be of benefit to young patients.

The correlation between echographic and histopathological findings in uveal melanoma.

PURPOSE: To correlate between the echographic and histopathological findings, and to search for important criteria for the prognosis in vivo using standardised echography. METHODS: The study included 51 consecutive patients treated by primary enucleation for choroidal or ciliary body melanoma and 30 patients who underwent secondary enucleation after failing radiotherapy treatment. All patients were treated during the period of 1998--2008 at the Eye Clinic of the 3rd Faculty of Medicine in Prague, Czech Republic. Standardised echography based on the Ossoinig method was used in this study. Histopathological processing and evaluation was performed by the Laboratory of Ocular Pathology at the same clinic. Professional statistical software (Statistica 7.1 by Statsoft, Inc.) was used for all statistical analysis. RESULTS: Statistically significant results were found in these correlations in the group of primary enucleation: US prominence vs. HP prominence (R = 0.8943, p = 0.0000), US base vs. HP base (R = 0.8060, p = 0.0000), US tumor shape vs. HP tumor shape (R = -0.7576, p = 0.0000), posterior choroidal spike condition vs. scleral invasion (R = -0.5341, p = 0.0005), TNM vs. pTNM (R = 0.7242, p = 0.0000). In the group of secondary enucleation: US prominence vs. HP prominence (R = 0.8132, p = 0.0000), US base vs. HP base (R = 0.7959, p = 0.0000). Other correlations were statistically insignificant. CONCLUSIONS: Tumor dimensions, shape of the tumor and scleral invasion are important predictors that can be in vivo reliably determined using standardised echography.

The suprabasal layer of corneal epithelial cells represents the major barrier site to the passive movement of small molecules and trafficking leukocytes.

AIMS: To investigate the site of barrier function to the passive diffusion of a small molecule (phalloidin) in the corneal epithelium in the mouse. METHODS: Penetration of phalloidin (molecular weight 1115 daltons) into the cornea was evaluated by studying fluorescent binding of phalloidin to actin in tissue sections, in whole mount preparations, and in the fixed intact globe by confocal microscopy. In addition, the location of tight junction proteins in the individual layers of the corneal epithelium was determined by immunohistochemistry. RESULTS: Phalloidin staining of corneal sections was positive in all corneal layers in tissue sections and in all layers of the corneal epithelium except the suprabasal layer in excised fixed whole mounts of the cornea. However, when phalloidin staining was attempted in intact fixed globes, before excision of the cornea for whole mount preparation, only the most superficial layer of cells was stained indicating that phalloidin could not penetrate the tissue beyond the suprabasal epithelial layer. Detergent (Triton X-100) treatment of the excised cornea and the intact fixed globe, allowed penetration of phalloidin into the suprabasal epithelial layer. Tight junction proteins occludin, ZO-1 and claudin were present in most layers of the cornea but while ZO-1 and occludin were distributed in a typical pericellular pattern, claudin seemed to be particularly prominent in the suprabasal layer and appeared only as a discontinuous punctate pericellular pattern in the superficial layer. Intraepithelial leukocytes were detected in the superficial epithelium and the basal epithelium but not in the suprabasal epithelium. CONCLUSION: The suprabasal epithelium cell layer appears to represent the main barrier site to the passage of small molecules and cells in the mouse cornea and this property may be attributable to prominent claudin expression in this layer.

[Angiolymphoid hyperplasia with eosinophilia with bilateral involvement of the lacrimal glands]. / Angiolymphoide Hyperplasie mit Eosinophilie mit bilateralem Befall der Tränendrüsen.

BACKGROUND: Angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura's disease are two rarely occurring disorders very similar to each other; however, they are individual nosological entities. For a long time they were considered as a single disease due to the frequency of similar characteristics. The majority of authors have recently considered these diseases as two individual entities with some reciprocal specifications, both clinical as well as morphological. PATIENT: We report on the case of a 76-year old male white European who had suffered for more than six years from subcutaneous tumour formations in different parts of the body. Eyelid oedema on the right side with palpable resistance under the upper temporal edge of the orbit initially occurred five years after the first symptoms of the disease. A similar finding occurred on the left side after eight months. The tumours on both sides were surgically removed and sent for histological analysis. A unilateral recurrence of the finding appeared after one year, followed by surgical intervention and histological examination. RESULTS: Tumour infiltrate in the first two orbita excisions was topically related to lacrimal gland structures; these structures were not found in the third excision. The case was histologically diagnosed as ALHE despite some similar characteristics with Kimura's disease. The diagnosis of ALHE was histologically supported, especially by the absence of lymphatic follicle formations and fibrotisation in the infiltrate, and the identification of the appearance of epitheloid up to histiocytoid of proliferating endothelium, which forms small lumens. The diagnosis of ALHE was additionally supported by the fact that the incidence of Kimura's disease in white Europeans is very rare. CONCLUSIONS: According to our findings, both entities overlap one another, even in some characteristics considered to be distinguishing. The question arises, therefore, whether the strict separation of these nosological entities can indeed be determined with one hundred percent accuracy.

Eye health care in the Czech Republic.

OBJECTIVE: An analysis of eye health care in the Czech Republic as of 1998 was performed. METHODS: A questionnaire was used to obtain information from all 59 in-patient eye departments. RESULTS: The number of ophthalmologists per 1 million inhabitants was 95. The number of cataract operations per 1 million inhabitants was 4,209: phaco-emulsification (36,926 surgeries, 85.2%), extracapsular extraction (6,094 surgeries, 14.1%) and intracapsular extraction (90 surgeries, 0.2%). Intra-ocular lenses were implanted in 99% of cases; 404 corneal transplantations and 1,220 operations for retinal detachment were performed. The number of pars plana vitrectomies for diabetic eye complications was 661. CONCLUSION: Selected regional clinical centres should be equipped and preferred by health insurance companies to provide comprehensive eye health care services and training.