Changes in donor corneal lenticule thickness after Descemet's stripping automated endothelial keratoplasty (DSAEK) with organ-cultured corneas.

AIMS: The aim of the study was to quantify changes in donor and host corneal tissue after Descemet's stripping automated endothelial keratoplasty (DSAEK) using organ-cultured corneas and to correlate these findings with the visual acuity during intermediate-term follow-up. METHODS: Fifteen eyes of 15 consecutive patients, with Fuchs' endothelial dystrophy treated with DSAEK using organ-cultured corneas, underwent ophthalmological examination, including slit lamp-adapted optical coherence tomography, at 1, 3 and 7 days, and 4 weeks, 8 weeks and 6 months after the surgery. RESULTS: The mean best spectacle-corrected visual acuity (BSCVA) improved from 20/100 pre-operatively to 20/40 at 6-months post-operatively (p<0.0001). A continuous decrease of thickness of the grafted lenticule was observed during the follow-up (mean thickness immediately after surgery 191(SD 56) mum, compared with 100 (SD 38) mum 6 months after surgery, p<0.001). The central corneal thickness decreased from 1057 (SD 86) mum at the first post-operative day to 661 (SD 74) mum after 6 months. Both central corneal thickness and the thickness of the posterior donor lamella correlated with the 6-month BSCVA (Pearson correlations -0.745 and -0.589, respectively, p<0.05). CONCLUSIONS: Organ-cultured corneas can be used successfully for DSAEK. The thickness of the grafted corneal lenticule correlated with the BSCVA 6 months after the surgery. It decreased continuously during the follow-up period.

[Patient satisfaction after posterior lamellar keratoplasty (DSAEK)]. / Patientenzufriedenheit nach posteriorer lamellärer Keratoplastik (DSAEK).

BACKGROUND: The advantages of posterior lamellar keratoplasty (DSAEK) compared to conventional full thickness keratoplasty are faster visual rehabilitation, little change in astigmatism and the absence of suture-associated complications. The current study evaluated the satisfaction of the first 15 patients who underwent DSAEK at our clinic. MATERIALS AND METHODS: Evaluation of patient satisfaction was conducted via a telephone survey and by means of a written patient questionnaire. The patients were asked to answer questions on a scale from 1 (very bad) to 10 (very good) about their overall satisfaction with this procedure, their satisfaction with the achieved postoperative visual acuity, their satisfaction with the progress of the healing process and the extent of the perceived burden. The patients were also asked whether they would opt again for the operation. Pre- and postoperative visual acuity, IOP, topographic astigmatism and corneal pachymetry were analysed. RESULTS: 15 eyes of 15 patients were analysed (12 women and 3 men). Average age at the time of operation was 75 +/- 7 years. Visual acuity increased and corneal thickness decreased primarily within the first three months. During that time there was an increase in overall patient satisfaction which finally reached 6.9 +/- 1.8 on the scale. Postoperative visual acuity was awarded with 7.2 +/- 2.0, progress of the healing process with 7.4 +/- 2.3. The procedure was not perceived as a big burden (8.0 +/- 1.9) and most patients would have decided again for the operation (8.2 +/- 2.0). There was no pre- and postoperative difference in IOP and corneal astigmatism. CONCLUSIONS: Like in our group patients with diseases of the corneal endothelium are of higher age and therefore benefit from a fast restitution of visual acuity and a low burden of operation. DSAEK represents a secure and practical procedure to rehabilitate elderly patients with diseases of the corneal endothelium.

[Differential diagnosis and treatment options for conjunctival tumors]. / Differenzialdiagnose und Therapieoptionen bei Tumoren der Konjunktiva.

The diagnostic classification of most conjunctival tumors is based on case history, inspection, and examination with the slit lamp microscope. Further imaging procedures are rarely indicated when malignant processes are not circumscribed. Clinical classification then also includes palpation and echographic examination of regional lymph nodes. Pigmented and nonpigmented melanocytic nevi are the most frequent conjunctival tumors. An important practical biomicroscopic cardinal symptom of the most frequent nevi is the presence of epithelial pseudocysts. Essential in practice is the histopathological confirmation of the clinical diagnosis, e.g., distinguishing between nonpigmented melanomas and sebaceous gland carcinomas with a pagetoid growth pattern or squamous cell carcinomas. Depending on the course and findings, the following therapeutic measures can be indicated: cryotherapy, chemotherapy, radiotherapy, modified enucleation, orbital exenteration, or a combination of different methods.