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Purpose: To evaluate the radiation effect of fractionated robotic radiotherapy of benign tumors located in the parasellar region on the anterior and posterior segments of the eye. Methods: A prospective observational study based on the expanded ophthalmological examination. The pre-treatment baseline was used as a control for the post-radiotherapy follow-up examinations. The study group consists of 34 patients (68 eyes) irradiated using the CyberKnife system. There were ten patients with cavernous sinus meningioma, nine with pituitary adenoma, five with meningioma of the anterior and middle cranial fossa, five with meningioma in the region close to optic chiasm, three with craniopharyngioma, and two with meningioma of the orbit. All patients were treated using three fractions of 600–800 cGy. We assessed the impact of radiation on the eye based on changes in anatomical and functional features. The condition of the eye surface, central corneal thickness (CCT), endothelial cell density (ECD), lens densitometry, central macular thickness (CMT), and retinal nerve fiber layer (RNFL) were the anatomical features assessed. The functional tests were best-corrected visual acuity (BCVA), intraocular pressure (IOP), visual field (VF) and visual-evoked potentials (VEP). An ophthalmologic examination was performed before and 6, 12, 18, and 24 months after radiotherapy. Results: We did not observe any significant changes in BCVA, IOP, CCT, CMT, VF, and VEP, nor in the slit-lamp examination during the two-years observation. We found a significant decrease in ECD at all follow-up measurements. The drop in ECD exceeded approximated age-related physiological loss. The reduction in ECD was not large enough to disrupt corneal function and thus affect vision. We also observed a statistically significant reduction of RNFL in all observation time points. However, there was no correlation between the dose delivered to the optic pathway and the decrease in RNFL thickness. The thinning of the RNFL was not significant enough to impair visual function. Conclusion: Fractionated robotic radiotherapy of the tumors located close to the optical pathway is safe and does not impair patient’s vision. Minor changes found in optic nerve anatomy (RNFL thinning) might be related to radiation effect or tumor compression. The causal relation between low doses of radiation delivered to the cornea and the observed significant but slight decrease in ECD is uncertain. The observed changes did not cause visual disturbances perceivable by the patients.

INTRODUCTION. The aim of the study was to evaluate the retinal nerve fibre layer (RNFL) thickness loss in primary open-angle glaucoma (POAG) patients treated topically with anti-glaucoma drops containing brimonidine and timolol combination or solely timolol. MATERIALS AND METHODS. Retrospective case series study of patients with POAG diagnosis followed up for a five-year period. Inclusion criteria were fulfilled by a group of 98 patients consisting of 53 combination and 45 monotherapy treatments. Intraocular pressure (IOP) at the level of 21 mm Hg or below for each measurement was observed in 52 patients, while incidences of pressure above 21 mm Hg were measured in 46 patients. POAG diagnosis was based on standard optical coherence tomography, IOP, and visual field examinations. RESULTS. Mean annual loss of RNFL thickness in the overall study group (if IOP levels are not taken into consideration) treated with timolol monotherapy was 1.8 ± 1.5 μm, while in group treated with brimonidine + timolol combination therapy it was 1.7 ± 1.5 μm (p > 0.05). In selected groups of patients with incidents of pressure rises, the mean annual loss of retinal nerve fibre layer thickness was 1.8 ± 1.6 and 1.9 ± 1.4 μm, respectively, for the monotherapy and combination therapy groups (p > 0.05). In the group of patients with no reported IOL rises, mean annual loss of RNFL thickness was 1.8 ± 0.9 and 1.1 ± 0.4 μm, respectively, for the monotherapy and combination therapy groups (p < 0.01). No significant differences were observed for the visual field mean deviation. CONCLUSIONS. POAG patients with low values of IOP might achieve slower progression of RNFL thinning on brimonidine combined with timolol therapy.

Purpose To analyse cytological features of corneal epithelium in infectious keratitis. Methods One hundred and eighteen patients (53 males and 65 females) diagnosed with acute stage of infectious keratitis (45 viral, 40 bacterial, 23 fungal, 10 Acanthamoeba keratitis) were included in study. We performed retrospective analysis of bright and blue-light slit-lamp photographs and in vivo corneal confocal microscopy scans of the corneal epithelium from five corneal regions (superior, inferior, temporal, nasal and central). Density, morphology of inflammatory cells and their relation to epithelial structures, as well as density of nerve fibres, were evaluated in relation to the keratitis aetiology. Results We characterized five morphological types of inflammatory cells forming infiltration. Cell and nerve fibre densities showed significant differences between groups, and the most intense inflammatory infiltration was associated with fungal then bacterial, viral and Acanthamoeba keratitis. Additionally, differences in aetiology-specific ratio of round/non-round inflammatory cells were observed. Conclusion Confocal microscopy analysis in infectious keratitis of various aetiologies revealed quantitative and qualitative differences in inflammatory cell infiltration expressed in different ratio of round/non-round inflammatory cells. In vivo microscopic analysis of both the corneal epithelial layer cytopathology and the cytology of inflammatory infiltration provides a fast and specific differentiation of keratitis aetiology that may increase the accuracy in the selection of the initial treatment.

Acetylenic amine derivatives of the 5,8-quinolinedione were synthesized and characterized by the 1H and 13C NMR, IR spectroscopy and MS spectra. Additionally, the 6- and 7-substituted allylamine-5,8-quinolinediones were synthesized for comparison purposes. The crystal structure was determined for the 6-chloro-7-propargylamine-5,8-quinolinedione and 7-chloro-6-propargylamine-5,8-quinolinedione. Additionally, the IR spectral analysis supplemented by the density functional theory (DFT) calculations were carried out. It was found that different positions of the propargylamine side chain had a distinct influence on crystal structure, formation of H-bonds and the carbonyl stretching IR bands. Correlation between the frequency separation Δν of the carbonyl IR bands and the position of the 6- and 7-substituents was found. The 7-substituted derivatives exhibited a higher frequency separation Δν. The observed correlation could provide an opportunity to use the IR spectroscopy to study substitution reactions. Cytotoxic activities against three human cancer cell lines for the 5,8-quinolinedione derivatives with different amine substituents, i.e., propargylamine, N-methylpropargylamine, 1,1-dimethylpropargylamine, allylamine and propylamine were also analysed with respect to their molecular structure.

Collagen fibrils type I display a typical banding pattern, so-called D-periodicity, of about 67 nm, when visualized by atomic force or electron microscopy imaging. Herein we report on a significant shortening of the D-period for human corneal collagen fibrils type I (21 ± 4 nm) upon air-drying, whereas no changes in the D-period were observed for human scleral collagen fibrils type I (64 ± 4 nm) measured under the same experimental conditions as the cornea. It was also found that for the corneal stroma fixed with glutaraldehyde and air-dried, the collagen fibrils show the commonly accepted D-period of 61 ± 8 nm. We used the atomic force microscopy method to image collagen fibrils type I present in the middle layers of human cornea and sclera. The water content in the cornea and sclera samples was varying in the range of .066-.085. Calculations of the D-period using the theoretical model of the fibril and the FFT approach allowed to reveal the possible molecular mechanism of the D-period shortening in the corneal collagen fibrils upon drying. It was found that both the decrease in the shift and the simultaneous reduction in the distance between tropocollagen molecules can be responsible for the experimentally observed effect. We also hypothesize that collagen type V, which co-assembles with collagen type I into heterotypic fibrils in cornea, could be involved in the observed shortening of the corneal D-period.

PURPOSE To evaluate the dynamics of cornea and graft thickness after Descemet stripping and endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) and to assess the usefulness of AS-OCT in monitoring graft adherence after DSEK. METHODS Eighty-eight eyes from 86 patients underwent DSEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. Central corneal thickness (CCT), endothelial graft thickness (GT), interface fluid presence, graft dislocation, rate of CCT, and GT changes were measured with an AS-OCT during 12-month follow up. RESULTS The CCT averaged 788 microm preoperatively. On postoperative Day 1, mean CCT was 816 microm and GT was 191 microm. Compared with CCT on the first day, the changes in CCT on 2, 3, and 7 days were statistically nonsignificant. From 1 month to 12 months after DSEK, the CCT significantly diminished (P < 0.001). The CCT dynamics closely correlated with changes of GT and of the recipient's part of cornea. The most rapid rate of thickness decrease was observed between 1 week and 1 month: 5.34 microm/day for the entire cornea and 2.54 microm/day for endothelial disc. Between 1 month and 1 year, the CCT and GT were stable with only a trend toward further decrease. Entrapped fluid at graft/host interface on the first postoperative day was detectable by slit-lamp examination in 14 eyes (16%) and in 28 eyes (32%) in OCT. CONCLUSION The recovery of endothelial pump after DSEK takes place between 1 week and 1 month after DSEK. AS-OCT can be practically used for evaluation of the cornea dynamics as well as for the qualitative and quantitative assessment of graft-host interface after DSEK.

Purpose To analyze the graft survival rate and stability of the corneal surface in patients who underwent limbal stem cell transplantation. Three surgical techniques were performed based on the origin of the ocular surface lesion: conjunctival limbal autograft (CLAU), living-related conjunctival limbal autograft (lr-CLAL), and keratolimbal allograft (KLAL) transplantations. Methods Nonrandomized consecutive comparative case series study. Eighty-four patients (90 eyes; 31 women and 53 men; age range: 11-78 years) were included in the study. Mean follow-up was 31.2 months (range: 6-72 months). Patients were divided into three groups: CLAU, lr-CLAL, and KLAL, comprising 21, 26, and 43 eyes, respectively. Graft survival rate and clinical success of the stem cell transplantation was confirmed by impression cytology. The Kaplan Meier survival curve and generalized Peto tests were used for the analyses. Results Graft survival rate and the regularity of the corneal surface differed significantly between the allo- and autografts. The 3-year and 6-year graft survival rates were 76.1% and 61.9%, respectively, for the autologous transplantation group, and 59.4% and 46.3%, respectively, for the allogeneic transplantation group. Corneal surface restoration correlated with positive staining for corneal epithelial cells in impression cytology. Conclusions Significantly better long-term outcomes were achieved with autotransplantation of the limbus compared with allogeneic limbal grafts from living-related and cadaveric donors.

To evaluate the usefulness of anterior segment optical coherence tomography (AS OCT) for initial diagnosis and for monitoring treatment results in eye injury cases.We examined 38 eyes of 34 patients with different types of ocular injuries: penetrating injury (eight eyes), perforating injury (two eyes), intraocular foreign body (four eyes), ocular burn (nine eyes), contusion (13 eyes), and lamellar laceration (two eyes). The mean age of the patients was 33.8 years. AS OCT examination was performed at the initial visit, directly after injury, and repeated as treatment progressed. Both anterior chamber components and corneal pachymetry were evaluated.Slit-lamp examination did not provide a clear diagnosis in three eyes after contusion because of a nontransparent cornea. In one case of a 44-year-old male patient, only corneal edema was noticed during slit-lamp examination, whereas AS OCT revealed Descemet's membrane detachment. In a 17-year-old male patient with blood infiltrating the cornea, OCT revealed acute angle closure with a pupillary block. In patients with corneal burns, OCT was valuable for monitoring the corneal healing progress after amniotic membrane application. OCT was also useful for determining whether a lamellar or penetrating technique should be applied in patients that qualified for corneal transplantation. In patients with foreign bodies, AS OCT was helpful in establishing the localization and size of the foreign body.AS OCT is a very valuable tool in ophthalmic departments dealing with ocular trauma, for early diagnosis and for monitoring treatment progress.

To evaluate the protective ability of the soft-shell technique in patients with senile cataract and Fuchs' dystrophy having phacoemulsification with intraocular lens (IOL) implantation.Department of Ophthalmology, Railway Hospital, Katowice, Poland.Sixty-one eyes of 54 patients (37 women, 17 men) with clinically confirmed Fuchs' dystrophy and cataract had clear corneal phacoemulsification and implantation of an intracapsular posterior chamber IOL with sodium hyaluronate 1% (Healon) or chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) in combination with sodium hyaluronate 1% (Provisc) in 1 package (DuoVisc). The central corneal thickness (CCT), measured with a Pocket Precision ultrasonic pachymeter (Quantel Medical, Inc.), was compared preoperatively and 1 day, 1 week, and 1 and 6 months postoperatively.The mean preoperative CCT was 549.5 microm +/- 29.3 (SD). The postoperative increase in CCT over preoperative pachymetry measurements remained statistically significant in both ophthalmic viscosurgical device groups throughout the entire follow-up, from the first day to the sixth month after surgery (P.0001). The maximum increase in CCT in both groups was on the first postoperative day, and it was significantly higher in the Healon group. Six months postoperatively, patients in the Healon group had a significantly greater CCT increase (P = .008).The soft-shell technique effectively protected the compromised endothelium in patients with Fuchs' dystrophy, proving its advantages in eyes with moderately damaged endothelium.

A 54-year-old man presented with corneal laceration, traumatized iris, small vitreous hemorrhage, lens opacity, and a 13-mm intraocular foreign body embedded in the retina. Pars plana vitrectomy and argon laser photocoagulation were performed. Using intraocular forceps, the object was forced into a 24-gauge needle that was inserted through the sclerotomy. The foreign body and the needle were removed from the eye. Phacoemulsification with foldable intraocular lens implantation in the ciliary sulcus was performed. Seven days after the surgery, the patient's visual acuity was 20/20 with spectacle correction of -3.5 diopters. The use of a needle tunnel during pars plana vitrectomy should be considered in similar cases of large, irregular intraocular foreign bodies to avoid severe and irreversible damage to the adjoining tissues. [Ophthalmic Surg Lasers Imaging 2004;35:70-73.]

Purpose To differentiate microbiological features of infectious keratitis in corneal epithelium. Methods We performed in vivo confocal microscopy (HRT III, Rostock Cornea Module) in 190 patients with diagnosed infectious keratitis of various etiology - 72 viral, 66 bacterial, 34 fungal (fibrillar and candidal) and 18 amoebal keratitis. For corneal scans we used 400x lens and 63x magnification. Microscopic analysis of epithelial layer was performed to distinguish structures of epithelial cells morphology, inflammatory cells and potential microbes. Results In viral keratitis, due to size of viral particles, highly specific secondary changes within epithelial cells were observed in form of “owl eyes”– an equivalent of active virus replication in cells. In bacterial keratitis we observed structures of bacteria forming streptococcal configuration (diagnosed bacteriologically as Streptococcus pneumoniae and Enterococcus spp.), granular bacteria could not be easily distinguished because of similarity with leukocytes infiltration (diagnosed bacteriologically as Staphylococci). In fungal keratitis we detected fungi fibrilles (diagnosed mycologically as Fusarium spp.) as well as granular fungi – Candida spp. Amoebal keratitis presented presence of Acantamoeba cysts and trophozoits. Conclusion In vivo analysis of corneal epithelial histology shows high specificity and sensitivity in infectious keratitis diagnosis. Except describing corneal structure and inflammatory cells, it makes possible to distinguish microbiological features of keratitis.

Purpose To evaluate immediate impact of hyaluronic and methylcellulose artificial tears on tear film stability. Methods We performed keratography with tear film analyze in 21 volunteers using Keratograph 4 (Oculus, Germany). After base measurement, volunteers received topical artificial tears drops containing 0.15% Sodium Hyaluronate into right eye and 0.5% Carboxyl Methylcellulose into left eye. After 15 and 30 minutes keratography measurements were repeated. Results In keratography analyzes we observed 4 types of tear film instability, short-time break-up on small area or big area, long-time break-up on small or big area. Mean size of tear meniscus in right eyes before drops was 0.3±0.1 mm and 0.32±0.09/0.33±0.09 mm 15/30 minutes after hyaluronic drops respectively (p 0.05, Kruskal-Wallis test). In left eyes these parameters were 12/16; 13/18 and 13/17 sec respectively before and after methylcellulose drops (p>0.05, Kruskal-Wallis test). Conclusion Immediate impact of hyaluronic and methylcellulose artificial tears on tear film seems to be related more to increase of tear meniscus size, not to tear film break-up time or break-up surface. Keratograhy measurements allow for detail analyzes of tear film state, which includes not only break-up time but also break-up surface, which could be novel indicator for tear film stability impossible to measure in classic slit lamp.

Purpose To perform increased intraocular pressure (IOP) screening in non-glaucomatous patients after deep anterior lamellar keratoplasty (DALK) due to keratoconus with normal IOP measured during control visits. Methods Ten non-glaucomatous patients, who underwent DALK procedure due to keratoconus were included into study. Patients were measuring IOP using self-tonometer Icare One (Icare, Finland) continuously for 30 days, 3 times per each day. Additionally patients were checked by ophthalmologist 3-times during follow-up time in Outpatient Clinic, where applanation tonometry and central corneal thickness measurements were performed. After 30-days, self-measured IOP was evaluated for rises above 21 mmHg as well as rises above mean GAT values measured during control visits. Results Mean IOP measured with GAT and adjusted according to CCT was 15 mmHg and ranged between 11 and 19 mmHg. There were no values above 21 mmHg reported during follow-up time. In Icare One measurements, all patients showed incidents of IOP values higher than measured with GAT, however mean values ranged between 10-18 mmHg. Six out of 10 patients revealed to have IOP elevations higher than 21 mmHg between control visits (with maximum values up to 46 mmHg), and this elevated values constituted from 3.3 up to 20.0 % of all self-measurements. Conclusion Self-tonometry with Icare One might be useful tool to identify patients who develop undetectable IOP increases between control visits. This can help in prevention of vision loss and transplant procedure failure in DALK patients.

Purpose To analyze histological findings of infectious keratitis in corneal epithelium including inflammatory cells infiltrations. Methods We performed in vivo confocal microscopy (HRT III, Rostock Cornea Module) in 190 patients with diagnosed infectious keratitis of various etiology - 72 viral, 66 bacterial, 34 fungal, 18 amoebal keratitis. For corneal scans we used 400x lens and 63x magnification. Microscopic analysis included inflammatory cells infiltration – number, size and shape of cells; superficial corneal nerve plexus (number and characteristics of nerve fibers) and cytology of epithelial cells. Described features were compared between groups. Results Inflammatory cells densities showed no differences between groups, however there was clearly different ratio of round/dendritic inflammatory cells, respectively 0.07, 8.0, 1.0, 1.2 for viral, bacterial, fungal and amoebal keratitis (U-Mann Whitney test, P

Purpose To present case of secondary, vocational crystalline keratopathy in patient with history of long-time exposure to glass wool. Methods The patient was consulted in Ophthalmology Outpatient Clinic because of suspicion of crystalline keratopathy of unknown origin. The following tests were performed: basic slit lamp examination, corneal scans using OCT Visante (Zeiss, Germany) and corneal confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina tomograph III). Results On a slit lamp examination we described macroscopic crystal deposits within epithelial layer. In the images from the OCT Visante - hiperreflective deposits obscuring other structures of the cornea were present only in epithelial and subepithelial layers. Crystals were not crossing Bowman membrane border. The corneal confocal microscopy images described monomorphic needle-like crystals without arborations, covered by epithelial cells and infiltrating epithelial layer, epithelial basal membrane and Bowman membrane. Anterior and posterior stroma presented no abnormalities. On anamnesis patient reported history of 25 years of occupational exposure to glass wool. Additionally we excluded other possible causes of crystalline keratopathy, such as hypercholesterolemia, hiperuricemia, cystinosis and hematopoietic disorders. Conclusion Corneal confocal microscopy is a useful tool for the detection and differentiation of corneal keratopathies of uncertain etiology.

Rheumatic diseases are frequently associated with eye disorders presenting with a wide range of signs and symptoms. Dry eye syndrome, keratitis, uveitis, scleritis and retinal vasculitis are often diagnosed in patients with rheumatic diseases. It is important not to overlook even subtle signs of ocular involvement as it may result in serious complications. Moreover in some cases ocular manifestation may help in proper diagnosis of systemic condition or indicate necessity of intensified treatment of underlying condition. Appropriate treatment of rheumatic diseases require careful follow up and involvement of various specialists including ophthalmologists as well as patient education.

To measure central macular thickness change after Nd: YAG capsulotomy using optical coherence tomography (OCT).55 patients (43 females and 12 males), mean age 65.1 +/- 13.9 years (range 21-87) who underwent Nd: YAG capsulotomy for posterior capsule opacification. Patients were examined preoperatively and one day, one week, one month, three months and six months after Nd: YAG capsulotomy. Central retinal thickness was measured by Stratus IV OCT Optical Coherence Tomography from Carl Zeiss Meditec, Inc. using "fast macular thickness" map protocol. All patients underwent ophthalmic examination including best-corrected visual acuity, fundus examination and intraocular pressure measurement.The initial median and range of the central retinal thickness was 212 microm (168-228), after one day 207 microm (168-232), after one week 207 microm (166-241), after one month 207 microm (163-252), after 3 months 207 microm (171-242), and 210 microm (170-235) 6 months after treatment. Proportional changes of the central retinal thickness was after one day -0.5 (-13.3 to 5.6), after one week 0.5 (-11.6 to 8.1), after one month -0.4 (-8.3 to 14.5), after 3 months 0.5 (-8.7 to 10.0) and 6 months after capsulotomy 0.5 (-5.8 to 7.7). There was no statistically significant change of the central macular thickness in any time point. Cystoid macular edema was observed in three patients 9.0 and 14 weeks after treatment. No other complications were noticed.Laser capsulotomy should be considered as a safe procedure for the macula. Optical coherence tomography is a useful diagnostic method that can be used in qualification and monitoring of patients undergoing Nd: YAG capsulotomy.

Meibomian gland dysfunction is a common ocular disorder affecting from 39 to 50% of population. Despite that, so far a pathophysiology path of the disease remains unknown, moreover there is no distinct border between physiology and the disease. There has been no clear diagnostic criteria. The purpose of this review was to combine a current knowledge of Meibomian gland anatomy, Meibomian gland dysfunction epidemiology, as well as presenting current definition, nomenclature, classification and diagnostic criteria. The importance of diagnosis associated with conditions such as aqueous tear deficiency, seborrheic dermatitis, and rosacea is emphasized. The available treatment methods are discussed. Meibomian gland dysfunction, blepharitis, dry eye syndrome.

Objective: To evaluate the safety and efficacy of 1 or 2 treatments with dexamethasone intravitreal implant (DEX implant) over 12 months in eyes with macular edema owing to branch or central retinal vein occlusion (BRVO or CRVO). Design: Two identical, multicenter, prospective studies included a randomized, 6-month, double-masked, sham-controlled phase followed by a 6-month open-label extension. Participants: We included 1256 patients with vision loss owing to macular edema associated with BRVO or CRVO. Methods: At baseline, patients received DEX implant 0.7 mg (n = 421), DEX implant 0.35 mg (n = 412), or sham (n = 423) in the study eye. At day 180, patients could receive DEX implant 0.7 mg if best-corrected visual acuity (BCVA) was 250 mu m. Main Outcome Measures: The primary outcome for the open-label extension was safety; BCVA was also evaluated. Results: At day 180, 997 patients received open-label DEX implant. Except for cataract, the incidence of ocular adverse events was similar in patients who received their first or second DEX implant. Over 12 months, cataract progression occurred in 90 of 302 phakic eyes (29.8%) that received 2 DEX implant 0.7 mg injections versus 5 of 88 sham-treated phakic eyes (5.7%); cataract surgery was performed in 4 of 302 (1.3%) and 1 of 88 (1.1%) eyes, respectively. In the group receiving two 0.7-mg DEX implants (n = 341), a >= 10-mmHg intraocular pressure (IOP) increase from baseline was observed in (12.6% after the first treatment, and 15.4% after the second). The IOP increases were usually transient and controlled with medication or observation; an additional 10.3% of patients initiated IOP-lowering medications after the second treatment. A >= 15-letter improvement in BCVA from baseline was achieved by 30% and 32% of patients 60 days after the first and second DEX implant, respectively. Conclusions: Among patients with macular edema owing to BRVO or CRVO, single and repeated treatment with DEX implant had a favorable safety profile over 12 months. In patients who qualified for and received 2 DEX implant injections, the efficacy and safety of the 2 implants were similar with the exception of cataract progression. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2011; 118: 2453-2460 (C) 2011 by the American Academy of Ophthalmology.

To present the results of deep anterior lamellar keratoplasty (DALK) using "big bubble" technique, performed from 2006 to 2008 in Ophthalmology Department, District Railway Hospital in Katowice.53 patients (53 eyes) underwent DALK using "big bubble" technique due to keratoconus, corneal dystrophies and postinflammatory corneal opacification with continue Descemet's membrane and healthy endothelium. Best corrected visual acuity, main astigmatism, central corneal thickness, endothelium cell density, intra- and postoperative complications were assessed.Mean follow up 15.4 months ranged from 11 to 24 months. Averaged best corrected visual acuity averaged equaled 0.6 and ranged from 0.1 to 4.0, mean astigmatism 2.6 D, ranged from 1.0 D to 2.6 D. Mean central corneal thickness was 503.4 microm and ranged from 379 microm to 694 microm, mean endothelium cell density before surgery equaled 2895/ mm2 and postoperatively 2398/ mm2. Incomplete Descemet's membrane detachment was diagnosed in 3 cases, intraoperative microperforations in 5 eyes and conversion to penetrating keratoplasty was needed in 4 patients. Postoperative disc opacity in 3 cases, increase of intraocular preassures in 1 case and early postoperative Descemet's membrane detachment in 1 eye. Posterior cataract formation in 4 eyes and in 1 case permanent mydriasis (Urrets-Zavalia Syndrome), was observed. There was no graft rejection observed.Although technically more demanding lamellar keratoplasty, could be considered as an alternative "gold standard" penetrating keratoplasty.

Objective: To evaluate the safety and efficacy of dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc., Irvine, CA) compared with sham in eyes with vision loss due to macular edema (ME) associated with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Design: Two identical, multicenter, masked, randomized, 6-month, sham-controlled clinical trials (each of which included patients with BRVO and patients with CRVO). Participants: A total of 1267 patients with vision loss due to ME associated with BRVO or CRVO. Intervention: A single treatment with DEX implant 0.7 mg (n = 427), DEX implant 0.35 mg (n = 414), or sham (n = 426). Main Outcome Measures: The primary outcome measure for the pooled data from the 2 studies was time to achieve a >= 15-letter improvement in best-corrected visual acuity (BCVA). Secondary end points included BCVA, central retinal thickness, and safety. Results: After a single administration, the time to achieve a >= 15-letter improvement in BCVA was significantly less in both DEX implant groups compared with sham (P= 15-letter improvement in BCVA was significantly higher in both DEX implant groups compared with sham at days 30 to 90 (P= 15-letter loss in BCVA was significantly lower in the DEX implant 0.7-mg group compared with sham at all follow-up visits (P 25 mmHg peaked at 16% at day 60 (both doses) and was not different from sham by day 180. There was no significant between-group difference in the occurrence of cataract or cataract surgery. Conclusions: Dexamethasone intravitreal implant can both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with ME secondary to BRVO or CRVO and may be a useful therapeutic option for eyes with these conditions.

To present the results of endothelial keratoplasty (DSEK) using "Busin" technique performed from September 2008 to December 2008 in Ophthalmology Department, District Railway Hospital in Katowice.7 patients (7 eyes) underwent DSEK using "Busin glide" technique, due to the corneal edema after cataract phacoemulsification. Best corrected visual acuity, central corneal thickness, endothelium cell density were assessed three and six month postoperatively.Mean time period between cataract surgery to DSEK was 15.8 month (from 11 to 37 months). The mean central corneal thickness before surgery was 750 microm (from 690 microm to 850 microm), mean best corrected visual acuity 0.001 (from light perception to 0.01). The average best corrected visual acuity three months after surgery was 0.4 (0.1 to 0.6), and 0.5 (from 0.1 to 0.7), six months. Mean central corneal thickness 3 months postoperatively equaled 790 microm (from 714 microm to 850 microm), and a sixth month was 659 microm (from 800 microm to 604 microm). Three months after DSEK, mean endothelium cell density was 2640/mm2 (from 2301/mm2 to 2904/mm2), six months after DSEK the average endothelial cell density equaled 2430/mm2 (from 2210/mm2 to 2780/mm2). Disc dislocation was not observed in studied group.The use of BG as a donor lenticule insertion technique in DSEK technique seems to be a safe support of this lamellar surgery.

Main purpose of this article is to present an actual review of application femtosecound laser in keratoplasty. Femtosecound laser keratome is a new option in corneal surgery that provides depth and diameter accuracy even at increased depth settings. It seems to be an ideal instrument to carry out stromal tissue cuttings in penetrating and lamellar keratoplasty as well as in refractive surgery. In this paper we also paid attention on adventages and disadventages of use FL, as well we compare this new technology with mechanical handheld microkeratomes.

To assess usefulness of optical coherence tomography (OCT) in adult-onset vitelliform macular dystrophy (AVMD) diagnosis. To assess retinal pathological changes during all stages of the disease.Retrospective case-series report. 16 patients (9 men, 7 women, mean age 60.25), with vitelliform macular dystrophy, who underwent ophthalmic examination including optical coherence tomography (OCT Stratus III, Zeiss Meditec, CA, USA) in 2005 and 2006. Retinal Thickness Map and Fast Retinal Thickness Map Acquisition Protocols were used during OCT scanning. Patients were evaluated with ETDRS charts, biomicroscopy, fluorescein angiography and electrophysiological exams.7 patients (44%) were referred to our outpatient clinic with diagnosis of macular hole, 7 patients (44%) with diagnosis of AMD. In 2 patients Best disease was suspected. Diagnosis of AVMD was possible to establish in all patients including medical history, fundus photography and OCT.OCT enables retinal morphology assessment and can be treated as the basis of adult-onset vitelliform macular dystrophy early evaluation, diagnosis differentiation and monitoring progression.

Purpose To evaluate visual recovery results in 11 patients with anterior pseudophakia and corneal endothelial dysfunction who had Descemet-stripping endothelial keratoplasty (DSEK) combined with anterior chamber intraocular lens (IOL) removal and scleral fixation of a posterior chamber IOL. Setting Department of Ophthalmology, District Railway Hospital Katowice, Katowice, Poland. Methods Eleven consecutive patients had DSEK combined with IOL exchange. Corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD), visual outcomes, and complication rates were measured during the follow-up. Results The mean age of patients was 76 years. All corneas remained clear during the mean 19.3-month follow-up. At the last visit, the mean uncorrected visual acuity was 0.16 (range 0.001 to 0.50) and the mean best corrected visual acuity, 0.36 (range 0.001 to 0.80). The mean spherical equivalent was +0.30 diopter (D) (range −2.00 to +2.25 D) and the mean astigmatism, 2.20 D (range 1.25 to 3.00 D). Three eyes with endothelial disk detachment required reinjection of air. Corneal rejection was observed in 1 eye 3 months postoperatively. Two eyes had flap erosion over the fixation suture. The mean CCT was 0.837 μm preoperatively and 0.605 μm postoperatively. The mean ECD was 3198 cells/mm 2 in donor lenticules and 2048 cells/mm 2 at the last follow-up visit. Endothelial cell loss was 36%. Conclusion Descemet-stripping endothelial keratoplasty combined with anterior chamber IOL replacement with a scleral-fixated posterior chamber IOL was a safe method for the management of pseudophakic bullous keratopathy.

Analysis of morphologic and functional outcomes of endothelial keratoplasty with descemetorhexis technique for recipient Descemet's membrane removal (DSEK).We analyzed patients treated for chronic endothelial dysfunction with DSEK technique. For the study 12 patients (12 eyes) with follow up at least 9 months, were qualified. Study group consisted of 9 women and 3 men, in age from 53 to 83 years, mean 72.9 +/- 7.82 years. All surgery were performed by one surgeon (EW). Anterior chamber was opened through 5 mm wide and 3 mm long sclero-corneal tunnel. Before descemetorhexis incision points on the endothelial side of cornea were done with radio-frequency diathermy. Descemet's membrane stripping was done with the forceps. Endothelial grafts were fixed with anterior chamber by air tamponade. We analyzed postoperative visual acuity (on Snellen's charts), corneal transparency, endothelial cell density, total central corneal thickness and endothelial button (with OCT Visante), and complications of the surgery.9 months postoperatively VA ranged from 0.1 to 0.5 (mean 0.28 +/- 0.15), BCVA ranged 0.1-0.9 (mean 0.43 +/- 0.30). Endothelial cell density ranged from 982 to 2781 cells per square millimeter (mean 1848.5 +/- 550.7). Total central corneal thickness ranged from 642 to 998 microm (mean 791.6 +/- 38.0 microm) before surgery and from 536 to 789 microm (mean 645 +/- 61.3 microm) 12 months postoperatively. Total central thickness of the endothelial graft 12 months postoperatively ranged from 42 to 163 microm (mean 89.1 +/- 38.2 microm). One penetrating keratoplasty was made for graft failure. Due to endothelial graft detachment or dislocation in anterior chamber, air tamponade was made in 5 cases with satisfactory final result. Only one case of the rejection was observed.Endothelial keratoplasty (DSEK) is safe and effective procedure in treatment of the endothelial cell dysfunction. Surgery supported by descemetorhrexis is easy and quick and results in smooth endothelial graft bed. The DSEK technique decreases surgery time and number of corneal graft dislocations.

Corneal endothelium is formed of 1 layer of mitochondria-rich cubic cells whose main role is to maintain corneal transparency. Corneal endothelial disorders represent group of both inherited and noninherited and may affect proper vision. A 36-year-old male patient with suspicion of corneal endothelial dystrophy underwent visual acuity, intraocular pressure, the basic slit-lamp examination, anterior segment optical coherence tomography (AS-OCT) (Visante, Carl Zeiss Meditec, Dublin, CA), and corneal confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III, Heidelberg, Germany). During the 3-year observation the patient reported symptoms mainly in the right eye. Slit-lamp examination revealed endothelial changes, much more pronounced in the right eye. Examination by the AS-OCT Visante showed hyperreflective dots within the right corneal endothelium. In order to assess endothelial cell morphology, analysis using corneal confocal microscopy in vivo was performed. Scans revealed presence of single endothelial deposits and severe cell changes of different morphology in both eyes. In the right eye, less pronounced changes of the polymorphic structure—polygonal guttas in different stages, linear and branched loss with “nuclear-like” formations and accompanying sediments. In the left eye, severe homomorphous polygonal “guttas-like” changes with “nuclear-like” formations were observed. Endothelial cysts’ features were dynamically changing during follow-up time with different effects on the patient's clinical state. Corneal confocal microscopy allows accurate imaging of the endothelial cells and their detailed characteristics. Structural changes within the endothelial cells are not always proportional to visual acuity and slit-lamp image. The presented case is an example of an unusual corneal endothelial syndrome with probably nondystrophic background due to observed dynamic state with regressive tendency.

To evaluate the clinical outcomes of corneal grafting for severe dry eye complications in bone marrow transplant recipients.Eleven eyes of nine patients with severe corneal complications of chronic graft-versus-host disease were treated from 2000 to 2005. The subjects underwent penetrating keratoplasty (n=9 eyes; seven for perforation and two for leucoma) or deep anterior lamellar keratoplasty (n=2 eyes) for deep postinflammatory stromal scarring without endothelial abnormalities. Patients were observed for graft survival, visual acuity, and postoperative complications.During the follow-up period (mean=21.6 months), nine grafts (82%) remained clear or almost entirely clear and gained more than two logarithmic units of best-corrected visual acuity. Two regrafts were necessary as the primary grafts became cloudy after 9 and 11 months. Persistent epithelial defects occurred in seven eyes (64%), cataract in six (55%), ocular hypertension in five (45%), corneal calcareous degeneration in two (18%), loss of clarity in two (18%), and sterile ulceration in one (9%).Corneal grafting was effective for restoring corneal clarity and improving visual function in this series of patients. Although the complication ratio was high and some patients required regrafting, there was a clinical improvement in the majority of patients.

Posterior lamellar keratoplasty (PLK) in patients with pseudophakic corneal oedema.The PLK have been performed in our department since November 2004. The studied group consisted of 8 patients (7 female and 1 male), 65 to 82 years of age (mean age: 71.5 years). Visual acuity before the surgery ranged from 0.01 to fingers counting. All the patients suffered from pseudophakic corneal oedema. Endothelial keratoplasty was performed using Melles technique: a deep stromal pocket was created across the cornea through a 5-mm scleral access incision. Endothelium was prepared from whole eyeballs collected according to the EEBA guidelines. Donor disc containing healthy endothelium was folded during the implantation procedure. Average donor endothelial cell density was 2800 cells/mm2. All surgeries were performed by one surgeon (EW).In two eyes conversion to PKP was necessary. Best corrected visual acuity (BCVA) ranged from 0.4 to 1.0 (mean 0.6 +/- 0.12). Postoperative astigmatism ranged from 0.75 to 2.5 D (mean 1.8 D +/- 0.34). Postoperative endothelial cell density ranged from 1700 do 2300 cells/mm2 (mean 2200 cells/mm2 +/- 150). Mean Postoperative endothelial cell loss came to 29%.Posterior lamellar keratoplasty is a feasible surgery to manage corneal endothelial disorders. Automation of procedures by the use of laser preparation of donor tissue and adaptation automatic microkeratomes will increase the afterrepeating of procedures.

The retrospective analysis of indications for keratoplasty.The study of 517 keratoplasties between May 2000 and December 2004.The indications were: corneal oedema--24,5%, keratoconus--18,1%, corneal leucoma--15,0%, limbus insufficiency--10,2%, Fuchs endothelial dystrophy--9,0%, graft decompensation--8,1%, other acquired keratopaties--5,9%, corneal perforation--5,8%, anterior and stromal dystrophies--2,3%, Peters' syndrome--0,38%, choristoma--0,19%.Main indication for keratoplasty are corneal oedema and keratoconus.

To assess clinical outcomes of the Ahmed glaucoma valve implant in patients with refractory glaucoma.15 patients (16 eyes), including 7 women and 8 men; patients with glaucoma: phakic- 10 eyes, pseudophakic - 4 eyes, and aphakic - 2 eyes, average age: 47.2 (18-72 years old), average IOP before the intervention: 47 mmHg (32-71 mmHg), average number of medications taken before the intervention: 3.0.Success was defined as IOP less than or equal to 21 mmHg and no need to perform another surgical intervention. Average period of observation was 23.2 months (6-42 months).Intervention was successful in 12 out of 16 eyes. Average number of medicaments taken after the intervention decreased to 1.2. 4 out of 16 patients had a hypertensive phase. Cumulative probabilities of success at 1 and 2 years were 88% and 72% respectively.hyphema - 4 eyes (25%), tube exposure - 1 eye (6.25%), corneal graft failure - 4 eyes (25%), hypertensive phase - 4 eyes (25%) anterior chamber shallowing - 2 eyes (12.5%)The Ahmed glaucoma valve implant is an effective way of treating the patients with refractory glaucoma.

We analyse effectiveness of corneal limbal cells' culture prepared from heart-beating organ donors, that include living donors and from cadaver donors buttons following 3 days storage in 4 degrees C in Likorol.For experiment 12 adults (living and heart-beating organ donors) aged 28-63 (mean 46.3) and 12 corneal buttons of cadaver (aged 18-51, mean 34.1) were qualified. Tissue samples (1 mm2) were taken from superior corneal limbus. Sample from living donor obtained during routine operation was sent immediately to laboratory, as well as from heart-beating organ donor. The limbal biopsy of preserved cornea was taken after 3 days storage in 4 degrees C (Likorol). Samples were treated with trypsin/EDTA solution before culture. Collected cells in similar density in 1 ml of medium laid on dishes inserts, covered with fibrin (Tissucol) and cultured in presence of feeder layer of fibroblasts (L929 line). Epithelial cells were cultured for 14 days at 37 degrees C in humidified 5% CO2 atmosphere in supplemented 2:1 mixture of DMEM and Ham's F12. On the 14th day cells were collected. Number of cells per 1 ml of medium was counted by cytometer. Immunostaining for epithelium type (Keratin 3) was performed.The number of cells obtained from cadaver donors reached 184.2+/-14.9% whereas from living donors revealed 1013.1+/-104.2%, increase in relation to number of delivered cells. We observed only 0.83+/-0.3 colonies per microscopic area in cultures from preserved tissue versus 6.67+/-0.6 colonies in cultures from living donor.The preservation in 4 degrees C in Likorol significantly decreases proliferative potential of the corneal limbus.

Purpose Vigorous eye rubbing is a cause of extensive hydrops in mentally retarded patients with keratoconus. We describe a new management approach for this condition. Design Prospective, noncomparative, consecutive case series. Participants Ten eyes of 10 mentally retarded patients aged 18 to 37 years (8 with Down syndrome and 2 with oligophrenia not associated with Down syndrome). All patients had extensive and persistent hydrops in the course of keratoconus that was refractory to traditional therapy. Intervention The patients underwent multifocal cauterization of the cornea combined with amniotic membrane transplantation. Main Outcome Measures Corneal protuberance, final corneal thickness, time to hydrops resolution, and postoperative complications were assessed. Results Hydrops was successfully resolved in all eyes. The mean initial corneal protuberance (7.6±4.2 mm) resolved after 21.4±9.5 days in all eyes. Mean final central corneal thickness was 0.47±0.11 mm. Extent of initial corneal protuberance, final corneal thickness, and time to resolution were positively correlated with each other. Conclusions Amniotic membrane transplantation with cauterization in this series of mentally retarded patients was a highly effective treatment for persistent hydrops related to keratoconus.

The cornea is an immune privileged site, but failure of corneal limbal stem cells is the cause of vascularisation, increasing the risk of immune response activity. The outcome after conjuctival limbal stem cells transplantation depends mainly on HLA system compatibility. HLA class I typing is one of the important factors considered in donor/recipient par matching. The aim of our study was the analysis of post transplant period in 16 related donor/recipient pars after limbal stem cells transplantation. We conclude that HLA class I and other immunogenetic factors compatibility (inside and out of the HLA region), may play the role in effective treatment.

The assessment of clinical outcome in patients after Ir-CLAL procedure.Retrospective, interventional case series including 11 patients (12 eyes), all with non-ambulatory visual acuity (from light perception to hand movements). Mean age was 39.4 years (ranging from 18 to 76 years). In 7 eyes Limbal Stem Cells Deficiency (LSCD) resulted from chemical burn, in 2 eyes from ocular cicatricial pemphigoid, in one eye from Stevens-Johnson syndrome (SJS). In one eye congenital LSCD was diagnosed and in another one post-inflammatory LSCD. Mean follow-up was 16.2 months (from 10 to 32). Among donors prospective class I HLA matching was performed. Maximal two mismatches were accepted. General immunosuppressive therapy was switched-on in all subjects. Surgical excision of corneal pannus with clearing of limbal area was performed. Five clock hours stem cells tissue grafts from living related donors were harvested and transplanted to the recipient eye. Three penetrating keratoplasty, one deep lamellar keratoplasty and seven amniotic membrane transplantations were additionally performed. Main outcome measures were graft survival as a restoration of corneal epithelium, visual acuity improvement and complication in donors and recipients. Kaplan-Meyer survival curve and generalized Peto test were used for comparison.The graft survival was 83.6% in mean 20.3 months follow-up (from 10 to 32 months). Two cases of graft failure concern eye with SJS and eye with PKP regrafting after chemical burn. Visual improvement in 7 cases (58.3%), the same visual acuity in 4 cases (33.3%) and deterioration one case (8.3%) were noted. Ambulatory vision in 50% of patients was achieved. Graft rejection syndrome in four eyes was noticed also when ideal matching and CsA serum level 220 ng/ml. Two cases were treated with success and another two grafts failed. No complications in donors eyes were noticed. Impression cytology in eyes with successful grafts not related to pathological changes.Lr-CLAL are effective in ocular surface restoration. Living-related donors are suitable source of stem cells for cultivation in vitro. The prognosis for stem cells grafting is definitely worse when eyelid anomaly and adhesions exist.

Limbal stem cells (LSC) deficiency is one among the causes of corneal transparency loss. The only effective management is LSC transplantation. In available techniques the source of donor tissue containing LSC can be healthy fellow eye (CLAU, EVELAU), living-related (lr-CLAL, lr-EVELAL) or cadaveric donor (c-CLAL). From among them, the most efficient and the safest procedure is transplantation of cultured stem cells. Preoperative diagnosis and ocular surface condition determine the choice, of which procedure is the best. The surgical restoration of ocular surface is the sequence of procedures and the penetrating keratoplasty is the ultimate rehabilitative step in this process.

To present own experiences in the surgery of deep lamellar keratoplasty.25 eye of 25 patients suffering from various corneal pathologies with preserved endothelium: 22 with keratoconus eyes, 2 with post-inflammatory scar and one eye with leucoma in Stevens-Johnson syndrome. Mean follow-up was 25.5 months (from 6 to 32). Main outcome measures were Non-Corrected and Best Corrected Visual Acuity (NCVA, BCVA), astigmatism, refractive error, IOP and corneal transparency. The surgery was performed in general anesthesia. In majority of cases the recipient stroma was trephined to a depth of 70% with 7.5 mm diameter vacuum trephine. In cases of intraoperative perforation of Descemet membrane with shallow anterior chamber we converted the procedure into penetrating keratoplasty. The donor lenticule was trephined in the artificial chamber with the 0.5 mm oversized manual trephine to a depth of 90%. In two cases after DLK was finished, limbal stem cell grafting was additionally performed.Postoperative NCVA ranged from 0.01 to 0.8 and BCVA from 0.1 to 0.8. Astigmatism ranged from 0.5 to 10.0 D. Refractive error ranged from -8.0 to +1.0 D. In follow-up period all grafts maintained transparent. The complications were mainly intraoperative perforations of Descemet membrane (9 cases): in 7 cases we convert the procedure into penetrating keratoplasty. In 2 cases the double chamber-forming was observed: in one case on 7 day following surgery the penetrating keratoplasty was performed, in other a spontaneous attachment was observed. We also observed loose sutures in 2 cases, inflammatory infiltrates in one case. Two cases of ocular hypertension was successfully treated by medication.Deep lamellar keratoplasty is an effective procedure for treating various diseases of corneal stroma with unaffected endothelium.

Purpose: To report a unique case of primary corneal melanoma. Methods: A 59-year-old white woman underwent keratectomy to remove a pigmented rapidly enlarging growth on the corner of her left eye. The specimen was submitted for histopathologic examination. Results: Ophthalmic examination disclosed no association with limbal or conjunctival melanocytic abnormalities. Histopathologic studies demonstrated nodular malignant melanoma. Conclusion: Possible development of primary corneal melanoma should be considered in diagnosing all cases with a past history of corneal melanin pigmentation.

PURPOSE. The aim of this study was to show the usefulness of three methods for measuring IOP: Goldmann applanation tonometry, rebound tonometry, and Ultra-High-Speed Scheimpflug technology. METHODS. The examined group consisted of 96 patients (192 eyes), including 63 women and 33 men with a mean age of 59.3 6 19.9 years. Together, 152 healthy eyes and 40 eyes with different pathologies were examined. Intraocular pressure was measured using the Goldmann applanation tonometer (GAT), the Icare Pro rebound tonometer (RT), and Ultra-High-Speed Scheimpflug technology (UHS ST; Corvis ST with pachymetry). Additionally, corneal pachymetry was conducted with a Scheimpflug camera (Pentacam) and an Ultrasound Pachymeter (A-scan Plus) as a comparison for Corvis ST pachymetry. RESULTS. The mean IOPs were 15.6 6 3.75 mm Hg, 15.6 6 3.5 mm Hg, and 16.1 6 4.0 mm Hg when measured with the GAT, the RT, and the UHS ST, respectively. The mean central corneal thickness (CCT) was 543.7 6 52.7 lm, 547.9 6 54.0 lm, and 556.25 6 38.8 lm as measured with the UHS ST, the Pentacam, and the Ultrasound Pachymeter, respectively. In comparison between devices, there was a significant difference between IOP values measured with the GAT and the RT versus the UHS ST (P < 0.001), and there was no significant difference between GAT and RT (P ¼ 0.5). No significant differences were observed in CCT measured with the UHS ST, Pentacam, and Ultrasound Pachymeter. CONCLUSIONS. We showed that the RT Icare Pro ensures IOP measurements that are more comparable with the measurements obtained with the GAT than the measurements that are provided by UHS ST.