What happens to the corneal transplant endothelium after penetrating keratoplasty?

PURPOSE: The aim of this study was to examine the human corneal endothelium of the transplant donor, wound, and adjacent host to determine the fate of the endothelial cells after penetrating keratoplasty. METHODS: We performed dissecting microscopic overviews and light and scanning electron microscopy on clear corneal transplant specimens obtained 1 month to 47 years after transplantation. The indications for the primary keratoplasty were keratoconus (11), Fuchs endothelial dystrophy (7), bullous keratopathy (6), others (5), and 8 cases without clinical data. RESULTS: We were able to visualize the wound and perform relative endothelial cell counts in 17 of 37 specimens. The wounds were of 4 shapes: smooth, anterior and/or posterior gaping, and anterior or posterior overriding. Any combination could be seen in the same specimen. Cells migrated from the center of the donor across the donor-host wound toward the host, but in all cases, the cells spread out, enlarged, and were ultimately lost. One case of Fuchs endothelial dystrophy may have had cell migration from the host across the wound to the donor. CONCLUSIONS: We confirmed that donor cells migrate from higher density to lower density across the transplant wound over time. Wound configuration, donor cell health, recipient endothelial health, and probable cell-to-cell contact inhibition are involved in this process.

A histopathologic review of undiagnosed neoplasms in 205 evisceration specimens.

PURPOSE: Evisceration and enucleation are 2 ophthalmic surgeries used to treat blind and painful eyes. The benefits of evisceration over enucleation are many but this procedure is contraindicated in cases of a suspected intra-ocular mass. Given the lack of such studies in the literature, our aim was to review a large sample of eviscerated specimens to document the prevalence of unexpected neoplasms. METHODS: During the study period (1994-2011), 13,591 human ophthalmic specimens were received at the Henry C. Witelson Ophthalmic Pathology Laboratory and Registry. Of those, 205 were evisceration specimens. Histopathologic reports were reviewed to retrieve relevant clinical information that included clinical diagnosis, age, gender, laterality, and final histopathologic diagnosis. RESULTS: The total number of unexpected neoplasms was 4 (1.95%) including 2 (0.97%) malignancies: necrotic melanoma (1), ciliary body adenoma (1), iris nevus (1), and spindle cell melanoma (1). All the other remaining eyes had histopathologic findings that were consistent with the underlying diagnosis. CONCLUSIONS: With proper pre-operative evaluation, including history, ophthalmologic examination, and imaging studies, the rate of unexpected neoplasms in evisceration specimens were low. Evisceration is a simpler and cheaper procedure when compared with enucleation, and our results corroborate its safety, whenever indicated to treat blind and/or painful eyes.

Mudanças nas indicaçöes de ceratoplastia penetrante 1990 - 1997 / Changing indications for penetrating keratoplasty 1990 -1997

Objetivo: Documentar as mudanças nas indicaçöes da ceratoplastia penetrante e comparar os resultados com as estatísticas de outros Serviços Universitários. Métodos: Analisamos as indicaçöes para a ceratoplastia penetrante dos pacientes incritos no Serviço de Córnea da Disciplina de Oftalmologia do Hospital Universitário Pedro Ernesto - UERJ entre 1995 e 1997. Resultados: As cinco indicaçöes mais freqüentes, em ordem decrescente, foram: ceratopatia bolhosa da pseudofacia (35.29 por cento), ceratocone (9.41 por cento), distrofia endotelial de Fuchs (8.24 por cento), ceratopatia bolhosa da afacia (7.06 por cento) e ceratite herpética (7.06 por cento).Conclusöes: Houve mudanças nas indicaçöes da ceratoplastia penetrante entre o atual estudo e o previamente realizado pelos autores em 1990.

Trauma ocular por himenópteros: relato de casos e revisäo de literatura / Ocular trauma caused by hymenoptera

Os autores apresentam dois casos de trauma ocular em razäo de ferroada de marimbondo, inseto da ordem dos himenópteros, mais frequentemente encontrado nas áreas rurais. As lesöes säo consequentes à açäo de componentes químicos tóxicos presentes no veneno dos insetos, que agem basicamente como alérgenos. Discute-se a fisiopatologia dos componentes do veneno inoculado, que ocasionam lesöes de intensidade variável

Hemorragia expulsiva: relato de um caso / Expulsive hemorrhage: a case report

Os autores relatam um caso de hemorragia expulsiva ocorrida durante uma ceratoplastia penetrante, complicaçäo rara e desastrosa da cirurgia intraocular, e fazem uma revisäo bibliográfica do assunto, com discussäo da patogênese e das medidas preventivas e curativas na ocorrência desta complicaçäo

Indicaçöes para a ceratoplastia penetrante / Indications for penetrating keratoplasty

Estudamos retrospectivamente os diagnósticos clínico e patológico de 49 ceratoplastias penetrantes realizadas no período de abril de 1988 a março de 1989, em 2 instituiçöes de ensino: Hospital Universitário Antônio Pedro, da Universidade Federal Fluminense. As indicaçöes mais frequentes, em ordem decrescente de frequência, foram a ceratopatia bolhosa da afacia (22,45%), a distrofia endotelial de Fuchs (16,33%), o ceratocone (14,28%), a ceratite intersticial (10,20%) e os re-enxertos (10,20%)