[Accuracy and relevance of CT volumetry in open ocular injuries with intraocular foreign bodies]. / Genauigkeit und Relevanz der CT-Volumetrie bei offenen Bulbusverletzungen mit intraokularen Fremdkörpern.

BACKGROUND/OBJECTIVES: The aim of the study was to evaluate the volume of intraocular foreign bodies (IOFB) using computed tomography (CT) volumetry as a prognostic factor for clinical outcome in open ocular injuries. PATIENTS AND METHODS: This study compared the volume of 11 IOFBs more than 5 mm(3) in size based on CT volumetry with the real size determined by in vitro measurement. A retrospective evaluation of clinical data, visual acuity, complications and relation of size of IOFBs with clinical outcome in 33 patients (mean age 41.0 ± 13.5 years) with open ocular injuries treated at our department between January 2005 and December 2010 was carried out. RESULTS: No significant differences were found between pairwise in vitro measurement and CT volumetric size (p = 0.07). All patients were surgically treated by pars plana vitrectomy. The mean follow-up time was 7.6± 6.2 months and the mean preoperative best corrected visual acuity (BCVA) was 0.063 ± 0.16 (logMAR 1.2 ± 0.79). Postoperatively, a mean BCVA of 0.25 ± 0.2 (logMAR 0.6 ± 0.69) could be achieved. Clinical outcomes were significantly better in injuries with small IOFBs measuring < 15 mm(3) (p = 0.0098). CONCLUSIONS: The use of CT volumetry is an accurate method for measurement of IOFBs. Exact data about the size and measurement of volume are also an important factor for the prognosis of clinical outcome in open ocular injuries with IOFBs and CT volumetry can also provide important information about the localization of IOFBs.

Confocal microscopic evidence of increased Langerhans cell activity after corneal metal foreign body removal.

PURPOSE: The purpose of the study was to examine the corneal inflammatory reaction and Langerhans cells with confocal microscopy after metal foreign body removal. METHODS: Corneal metal foreign body was removed from 9 eyes of 9 consecutive patients 12.1+/-13.6 (4 to 72) hours after superficial angle grinder injury. Both eyes were examined with the Heidelberg Retina Tomograph II (HRT II) Rostock Cornea Module. Morphology and density of epithelium, nerves, metal deposits, keratocytes, endothelium, and Langerhans cells were compared to the uninjured fellow eyes (controls). RESULTS: Irregularity and partially missing superficial epithelium was found in all cases. Around the area of injury prolonged basal and wing epithelial cells were found in all eyes. The basal epithelium density is lower than in the control eye (p=0.043). Density of Langerhans cells (68.1+/-24.2/mm2) was increased in the epithelium, compared to controls (35.2+/-21.8/mm2, p=0.012). Keratocyte and endothelium densities were not different from that of controls. Some keratocytes showed signs of activation and the inhomogeneous background reflectivity revealed extracellular matrix alterations. Inflammatory reaction was observed up to260 micronm depth. The metal foreign body particles had high reflectivity and irregular edge. CONCLUSIONS: In vivo confocal microscopy provided additional information to biomicroscopic signs such as epithelial damage and inflammation. It showed the effects of metal foreign bodies in the cornea: nerve damage and Langerhans cell density increase. Langerhans cells seem to play an important role in the inflammatory response after corneal foreign body injuries.

Corneal topography parameters after superior clear corneal incision cataract surgery in arcus lipoides.

PURPOSE: To compare changes in corneal topographic parameters after cataract surgery in eyes with different severities of arcus lipoides. METHODS: Fourty eyes of 40 patients (23 women, 17 men, age 71.3+/-20.4 years, range 40 to 89 years) were studied prospectively in a consecutive, non-interventional, comparative series of cases. Eyes were classed in three groups (0 to 2) according to the assessed grade of arcus lipoides (none, <180 degrees, >180 degrees). Corneal topography (Tomey TMS-2) was performed preoperatively and at 1 and 10 days and 1 and 3 months following cataract surgery (superior 4.0 mm clear corneal incision, no suture). Keratometric astigmatism (Dcyl), surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) were evaluated for the different groups and time-points, using the Kruskal-Wallis, Wilcoxon, and Mann-Whitney statistical tests. RESULTS: No significant preoperative difference was found in mean Dcyl, SRI, or PVA; preoperative SAI was lower in Group 1. Postoperatively Dcyl was increased at day 1 in Groups 1 and 2, and remained higher in Group 2 until month 1. At month 3 significant differences among Groups 0, 1, and 2 disappeared. CONCLUSIONS: The 4.0 mm superior clear corneal incision is a safe method for cataract surgery in the presence of arcus lipoides. This procedure induces greater corneal astigmatism, surface irregularity, and lower PVA in the early postoperative period in cases with arcus lipoides than in normal corneas. Concerning final results, wound healing was not affected by greater severity of arcus lipoides, although stabilization of the corneal surface tended to be slower.