Long-Term Dehydrated Donor Lamella Survival in Anterior Keratoplasty: Keratocyte Migration and Repopulation of Corneal Stroma.

PURPOSE: The aim of this study was to investigate the ability of host keratocytes to colonize the donor lamella transplanted without viable cells (dehydrated) in Descemetic (deep anterior lamellar keratoplasty) and in pre-Descemetic keratoplasty (excimer laser-assisted lamellar keratoplasty). METHOD: A total of 17 eyes (8 deep anterior lamellar keratoplasties and 9 excimer laser-assisted lamellar keratoplasties) were included in this observational retrospective study; patients underwent ophthalmic examinations, and histological staining was performed ex vivo on the graft in cases of failure. RESULTS: In Descemetic keratoplasty, the long-term survival of the graft is compromised with the central corneal thickness decreasing; corneal pachymetry and in vivo and ex vivo keratocyte densities are significantly reduced (pachymetric reduction of -86 µm in the apex and -87 µm in the thinnest point; density cell reduction of 72% at a depth of 100 µm, 62% at a depth of 250 µm, and -66% at a depth of 400 µm). In pre-Descemetic keratoplasty, clinical complications, reduction of central thickness, or alterations of keratocyte density were not observed. CONCLUSIONS: In Descemetic keratoplasty, the migration of the host peripheral keratocytes does not seem enough to repopulate the donor graft, whereas in pre-Descemetic keratoplasty, long-term survival of the graft is good. Keratocyte repopulation was observed only by extensive contact between the donor and host parenchyma.

Matrix metalloproteinases and their tissue inhibitors after selective laser trabeculoplasty in pseudoexfoliative secondary glaucoma.

BACKGROUND: The aim of this study was to assess changes in metalloproteinases (MMP-2) and tissue inhibitor of metalloproteinases (TIMP-2) following selective laser trabeculoplasty (SLT) in patients with pseudoexfoliative glaucoma (PEXG). METHODS: We enrolled 15 patients with PEXG and cataracts (PEXG-C group) and good intraocular pressure (IOP) controlled with beta-blockers and dorzolamide eye drops who were treated by cataract phacoemulsification and 15 patients with pseudoexfoliative glaucoma (PEXG-SLT group). The PEXG-SLT patients underwent a trabeculectomy for uncontrolled IOP in the eye that showed increased IOP despite the maximum drug treatment with beta-blockers and dorzolamide eye drops and after ineffective selective laser trabeculoplasty (SLT). The control group consisted of 15 subjects with cataracts. Aqueous humor was aspirated during surgery from patients with PEXG-C, PEXG-SLT and from matched control patients with cataracts during cataract surgery or trabeculectomy. The concentrations of MMP-2 and TIMP-2 in the aqueous humor were assessed with commercially available ELISA kits. RESULTS: In PEXG-SLT group in the first 10 days after SLT treatment a significant reduction in IOP was observed: 25.8 +/- 1.9 vs 18.1.0 +/- 1.4 mm/Hg (p < 0.001), but after a mean time of 31.5 +/- 7.6 days IOP increased and returned to pretreatment levels: 25.4 +/- 1.6 mm/Hg (p < 0.591). Therefore a trabeculectomy was considered necessary.The MMP-2 in PEXG-C was 57.77 +/- 9.25 microg/ml and in PEXG-SLT was 58.52 +/- 9.66 microg/ml (p < 0.066). TIMP-2 was 105.19 +/- 28.53 microg/ml in PEXG-C and 105.96 +/- 27.65 microg/ml in PEXG-SLT (p < 0.202). The MMP-2/TIMP-2 ratio in the normal subjects was 1.11 +/- 0.44. This ratio increase to 1.88 +/- 0.65 in PEXG-C (p < 0.001) and to 1.87 +/- 0.64 in PEXG-SLT (p < 0.001). There was no statistically significant difference between the PEXG-C and PEXG-SLT ratios (p < 0.671). CONCLUSION: This case series suggest that IOP elevation after SLT can be a serious adverse event in some PEXG patients. The IOP increase in these cases would be correlated to the failure to decrease the TIMP-2/MMP-2 ratio. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79745214.

Intravitreal vs. subtenon triamcinolone acetonide for the treatment of diabetic cystoid macular edema.

BACKGROUND: To assess the efficacy of the intravitreal (IVT) injection of Triamcinolone Acetonide (TA) as compared to posterior subtenon (SBT) capsule injection for the treatment of cystoid diabetic macular edema. METHODS: Fourteen patients with type II diabetes mellitus and on insulin treatment, presenting diffuse cystoid macular edema were recruited. Before TA injection all focal lakes were treated by laser photocoagulation. In the same patients one eye was assigned to 4 mg IVT injection of TA and the fellow eye was then treated with 40 mg SBT injection of TA. Before and one, three and six months after treatment we measured visual acuity with ETDRS chart as well as thickness of the macula with optical coherence tomography (OCT) and intraocular pressure (IOP). RESULTS: The eyes treated with an IVT injection displayed significant improvement in visual acuity, both after one (0.491 +/- 0.070; p < 0.001) and three months (0.500 +/- 0.089; p < 0.001) of treatment. Significant improvement was displayed also in eyes treated with an SBT injection, again after one (0.455 +/- 0.069; p < 0.001) and three months (0.427 +/- 0.065; p < 0.001). The difference between an IVT injection (0.809 +/- 0.083) and SBT injection (0.460 +/- 0.072) becomes significant six months after the treatment (p < 0.001). Macular thickness of the eyes treated with IVT injection was significantly reduced both after one (222.7 +/- 13.4 microm; p < 0.001) and after three months (228.1 +/- 10.6 microm; p < 0.001) of treatment. The eyes treated with SBT injection displayed significant improvement after one (220.1 +/- 15.1 microm; p < 0.001) and after three months (231.3 +/- 10.9 microm; p < 0.001). The difference between the eyes treated with IVT injection (385.2 +/- 11.3 microm) and those treated with SBT injection (235.4 +/- 8.7 microm) becomes significant six months after the treatment (p < 0.001). Intraocular pressure of the eyes treated with IVT injection significantly increased after one month (17.7 +/- 1.1 mm/Hg; p < 0.020), three (18.2 +/- 1.2 mm/Hg; p < 0.003) and six month (18.1 +/- 1.3 mm/Hg; p < 0.007) when compared to baseline value (16.1 +/- 1.402 mm/Hg). In the SBT injection eyes we didn't display a significant increase of intraocular pressure after one (16.4 +/- 1.2 mm/Hg; p < 0.450), three (16.3 +/- 1.1 mm/Hg; p < 0.630) and six months (16.2 +/- 1.1 mm/Hg; p < 0.720) when compared to baseline value (16.2 +/- 1.3 mm/Hg). CONCLUSION: The parabulbar subtenon approach can be considered a valid alternative to the intravitreal injection. TRIAL REGISTRATION: Current Controlled Trials ISRCTN67086909.

Ocular surface and intraocular inflammation are related in SS-I and rheumatoid arthritis patients.

The purpose of this study is to evaluate the intraocular inflammation at a sub clinical level, in patients suffering from Sjogren's syndrome (SS-I) and Rheumatoid Arthritis (RA), to relate it with the ocular surface status and to verify the diagnostic performance of the method. Twenty-eight patients suffering from SS-I, 31 patients suffering from RA and 31 normal subjects matched in age and gender were included in the study. A Kowa 500F laser cell flare meter was utilized to quantify the aqueous cells and flare in vivo, ocular surface inflammation was graded by conjunctival cytology and dosage of serum albumin in tears, eye dryness was scored with Tear Function Index. All data resulted significantly different in both SS-I and RA patients vs. control group and also different comparing SS-I vs. RA patients group, except for the Flare values. A blood-aqueous barrier breakdown occurs either in SS-I and RA patients; the degree of the damage is related with ocular surface inflammation and dryness. We recommend the aqueous flare be analysed in those rheumatic patients where an ocular surface inflammation has been documented.