[Corneoscleral transplant excision in the cadaver. Experiences of the North Rhine Westphalia Lions Cornea Bank 1995 and 1996]. / Korneosklerale Transplantatentnahme an der Leiche. Erfahrungen der Lions-Hornhautbank Nordrhein-Westfalen in den Jahren 1995 und 1996.

BACKGROUND: Donor corneas are normally obtained by whole globe enucleation-a procedure often refused by the bereaved. To increase the acceptance of cornea donation, we have exclusively obtained donor corneas by in situ excision since the end of 1994. There have been reports of increased endothelial damage and higher contamination rates. We report our experience in 1995 and 1996. METHODS: The in situ excision was performed by staff trained in microsurgical techniques. Only donor corneas with negative end-storage cultures after at least 10 days and an endothelial cell count of more than 2500 cells/mm2 were used for transplantation. RESULTS: In all, 705 corneoscleral buttons were excised from 1/95 to 12/96. The bereaved consented in 34% in 1996. A total of 30.5% of the corneas were ineligible for transplantation which corresponds to the discard figures from all cornea banks with culture methods. We did not observe any primary transplant failure nor endophthalmitis after 444 perforating keratoplasties. CONCLUSION: In situ corneal excision is safe, and helps to reduce the shortage in donor corneas.

[Acute band-shaped keratopathy after intraocular fibrinolysis with recombinant tissue plasminogen activator (rt-PA)]. / Akute bandförmige Keratopathie nach intraokularer Fibrinolyse mit rekombinantem Tissue-Plasminogen-Aktivator (rt-PA).

BACKGROUND: Intraocular fibrinolysis with recombinant tissue-plasminogen activator (rt-PA) in patients with severe fibrin reactions following anterior segment surgery is widely accepted because of the low complication rate. CASES: We present two eyes of two patients developing acute bandkeratopathy within the first week after intraocular rt-PA fibrinolysis (10 mg/100 ml). In the first patient, calcium deposition occurred inferiorly of the optic axis without visual impairment. In the second patient, a dense bandkeratopathy reaching from limbus to limbus developed, with a severe decrease of vision. A corneal abrasion together with the chelating agent disodium ethylene diamine tetra-acetate (EDTA) 0.5% in neutral solution led only to an incomplete resolution of the depositions. CONCLUSIONS: Acute development of a bandkeratopathy is very rare. Several risk factors are identified so far, e.g. the use of phosphate containing eye drops. Their interactions and the possible pathomechanism are discussed in detail. The close coincidence of intraocular rt-PA fibrinolysis and acute band-keratopathy in our two patients is in favor of an at least additive causative role of rt-PA fibrinolysis. Therefore, the indication should be limited to severe fibrin reactions and local application of phosphate containing drugs should be avoided.