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Anterior Chamber (anterior + chamber)
Terms modified by Anterior Chamber Selected AbstractsCataract surgery in previously vitrectomized eyesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2008A. Akinci Summary Purpose:, To evaluate the results of extracapsular cataract extraction (ECCE) and phacoemulsification (PHACO) performed in previously vitrectomized eyes. Material and method:, In this retrospective study, 56 vitrectomized eyes that had ECCE and 60 vitrectomized eyes that had PHACO were included in the study group while 65 eyes that had PHACO in the control group. The evaluated parameters were the incidence of intra-operative and postoperative complications (IPC) and visual outcomes. Chi-squared, independent samples and paired samples tests were used for comparing the results. Results:, Deep anterior chamber (AC) was significantly more common in the PHACO group of vitrectomized eyes (PGVE) and observed in eyes that had undergone extensive vitreous removal (p < 0.05). Except for this there were no significant differences in the rate of IPC between the ECCE group and the PGVE (p > 0.05). Some of the intra-operative conditions such as posterior synechiae, primary posterior capsular opacification (PCO) and postoperative complications such as retinal detachment (RD), PCO were significantly more common in vitrectomized eyes than the controls (p < 0.05). There was no significant difference in the visual acuity gain between the ECCE group and the PGVE (p > 0.05). Conclusion:, Deep AC is more common in eyes with extensive vitreous removal during PHACO than ECCE. Decreasing the bottle height is advised in this case. Except for this, the results of ECCE and PHACO are similar in previously vitrectomized eyes. Posterior synechiaes, primary and postoperative PCO and RD are more common in vitrectomized eyes than the controls. [source] Development of the swimbladder and its innervation in the zebrafish, Danio rerioJOURNAL OF MORPHOLOGY, Issue 11 2007G.N. Robertson Abstract Many teleosts including zebrafish, Danio rerio, actively regulate buoyancy with a gas-filled swimbladder, the volume of which is controlled by autonomic reflexes acting on vascular, muscular, and secretory effectors. In this study, we investigated the morphological development of the zebrafish swimbladder together with its effectors and innervation. The swimbladder first formed as a single chamber, which inflated at 1,3 days posthatching (dph), 3.5,4 mm body length. Lateral nerves were already present as demonstrated by the antibody zn-12, and blood vessels had formed in parallel on the cranial aspect to supply blood to anastomotic capillary loops as demonstrated by Tie-2 antibody staining. Neuropeptide Y-(NPY-) like immunoreactive (LIR) fibers appeared early in the single-chambered stage, and vasoactive intestinal polypeptide (VIP)-LIR fibers and cell bodies developed by 10 dph (5 mm). By 18 dph (6 mm), the anterior chamber formed by evagination from the cranial end of the original chamber; both chambers then enlarged with the ductus communicans forming a constriction between them. The parallel blood vessels developed into an arteriovenous rete on the cranial aspect of the posterior chamber and this region was innervated by zn-12-reactive fibers. Tyrosine hydroxylase- (TH-), NPY-, and VIP-LIR fibers also innervated this area and the lateral posterior chamber. Innervation of the early anterior chamber was also demonstrated by VIP-LIR fibers. By 25,30 dph (8,9 mm), a band of smooth muscle formed in the lateral wall of the posterior chamber. Although gas in the swimbladder increased buoyancy of young larvae just after first inflation, our results suggest that active control of the swimbladder may not occur until after the formation of the two chambers and subsequent development and maturation of vasculature, musculature and innervation of these structures at about 28,30 dph. J. Morphol., 2007. © 2007 Wiley-Liss, Inc. [source] Male genital system and spermiogenesis of Nanorchestes amphibius (Acari: Endeostigmata: Nanorchestidae): Anatomy, histology, and evolutionary implicationsJOURNAL OF MORPHOLOGY, Issue 2 2003Gunnar Müller Abstract In the present article the anatomy and histology of the male genital system of an endeostigmatid mite are described for the first time. The Endeostigmata probably are a paraphyletic group supposed to include the most primitive actinotrichid mites. In Nanorchestes amphibius, the testis comprises a paired germinal region connected with an unpaired glandular region. In the germinal region, spermiogenesis takes place in cysts of a somatic cell containing germ cells representing the same developmental stage. In the lumen of the glandular region, the spermatozoa are stored together with secretions of the glandular epithelium. These secretions are probably involved in the formation of spermatophores. From the glandular region, spermatozoa and secretions are released into the vasa deferentia that histologically can be divided into three sections, beginning with a short paired region with strong circular muscles serving as a sphincter, continuing with a paired proximal zone, followed by a short unpaired distal section. The distal vas deferens leads into the chitinous, unpaired ductus ejaculatorius which is followed by the progenital chamber. The ductus ejaculatorius is composed of a proximal section and a proximal, central, and anterior chamber. It is accompanied by a complex system of muscles and sclerites probably involved in the formation and ejaculation of the spermatophore. A similar organization can also be found in Prostigmata, but not in Oribatida. Anterior to the progenital chamber is located a paired accessory gland that probably produces a lipid secretion. Spermiogenesis is characterized by disintegration of the nuclear envelope, condensation of chromatin, and extensive reduction of the amount of sperm cell cytoplasm. The mature aflagellate, U-shaped spermatozoa are simple in structure and lack mitochondria and an acrosome complex. The results do not support the current view that Nanorchestidae are more closely related to Sarcoptiformes, i.e., Oribatida and Astigmata, than to Prostigmata. J. Morphol. 257:171,180, 2003. © 2003 Wiley-Liss, Inc. [source] Non-invasive monitoring of commonly used intraocular drugs against endophthalmitis by raman spectroscopyLASERS IN SURGERY AND MEDICINE, Issue 4 2003K. Hosseini MD Abstract Purpose To develop a non-contact and non-invasive method for quantification of the local concentration of certain antibiotic and antifungal drugs in the eye. Study Design/Materials and Methods An integrated CCD-based Raman spectroscopic system designed specifically for ophthalmic applications was used to non-invasively detect the presence of ceftazidime and amphotericin B in ocular media. Specific Raman signatures of the above named drugs were determined for various concentrations that were injected through a needle in the aqueous humor of rabbit eyes in vivo. Raman spectra were subsequently acquired by focusing an argon laser beam within the anterior chamber of the eye. Results Compared to ocular tissue, unique spectral features of ceftazidime appeared near 1,028, 1,506, 1,586, and 1,641 cm,1. Amphotericin B exhibited its characteristic peaks at 1,156.5 and 1,556 cm,1. The amplitude of the spectral peak corresponding to these drugs (acquired by 1 second exposure time and 25 mW of laser power) were determined to be linearly dependent on their local concentration in the anterior chamber of the eye. Conclusions Raman spectroscopy may offer an effective tool to non-invasively assess the local concentration of the delivered drugs within the ocular media. This technique potentially could be used to investigate the pharmacokinetics of intraocular drugs in vivo either from a releasing implant or a direct injection. Lasers Surg. Med. 32:265,270, 2003. © 2003 Wiley-Liss, Inc. [source] Effects of age and GDNF on noradrenergic innervation of the hippocampal formation: Studies from intraocular graftsMICROSCOPY RESEARCH AND TECHNIQUE, Issue 5 2001A.-C. Granholm Abstract Recent studies have suggested that factors in the target tissue influence the degree of plasticity and regeneration following aging and/or specific insults. We have investigated whether young or aged targets differ in their noradrenergic innervation from fetal locus coeruleus (LC) neurons, and also if a specific growth factor, glial cell line-derived neurotrophic factor (GDNF) can affect this innervation pattern. Tissue pieces of fetal brainstem and young (3 months) or old (18 months) iris tissue were transplanted simultaneously into the anterior chamber of the eye of adult hosts. We found that aged iris transplants became innervated to a significantly lesser degree by the cografted LC neurons than young iris transplants. Fetal hippocampal tissue was then grafted to adult hosts, and a fetal brainstem graft containing LC neurons was placed adjacent to the first graft, either at 3 or 21 months post-grafting. Thus, old/young chimeras of the noradrenergic coeruleo-hippocampal pathway were created. Aged hippocampal grafts received a much less dense innervation from co-grafted LC neurons than young hippocampal grafts. Tyrosine hydroxylase-positive-immunoreactive innervation was only found in the outskirts of aged grafts, while the young hippocampal grafts contained an even innervation pattern. The innervation density of hippocampal grafts was significantly enhanced by GDNF treatment. These findings demonstrate that target-derived factors may regulate neuronal plasticity, and that the age of the target is more important for innervation properties than the age of the neuron innervating a particular target. Microsc. Res. Tech. 54:298,308, 2001. © 2001 Wiley-Liss, Inc. [source] Serious complications of cosmetic NewColorIris implantationACTA OPHTHALMOLOGICA, Issue 6 2010Justin E. Anderson Acta Ophthalmol. 2010: 88: 700,704 Abstract. Purpose:, This case report describes serious postoperative complications and markedly elevated intraocular pressure (IOP) associated with the NewColorIris cosmetic implant. Methods:, We report an interventional case series of two patients who suffered multiple complications after NewColorIris implantation carried out in Panama. Assessment included visual acuity, photography, endothelial cell count and anterior segment optical coherence tomography (OCT) when possible. Results:, Both patients presented with endothelial cell loss, uveitis, pigment dispersion and elevated IOP. Anterior segment OCT demonstrated irregularities in the position and configuration of the implants within the anterior chamber with resultant areas of implant,iris and implant,endothelial contact. One patient had acute postoperative hyphaema that resolved with anterior chamber tissue plasminogen activator injection. Both patients required explantation OU, one eye has required trabeculectomy, and one eye with bullous keratopathy is being evaluated for Descemet's stripping endothelial keratoplasty. Conclusions:, Implantation of the NewColorIris cosmetic implant can lead to serious complications including hyphaema, uncontrolled IOP, severe endothelial cell loss, bullous keratopathy and anterior uveitis. Explantation may lead to improvement, but permanent damage to the trabecular meshwork and corneal endothelium persists. [source] Effect of age on anterior chamber angle configuration in Asians determined by anterior segment optical coherence tomography; clinic-based studyACTA OPHTHALMOLOGICA, Issue 6 2010Mi Hyun Cheon Acta Ophthalmol. 2010: 88: e205,e210 Abstract. Purpose:, To evaluate the distribution of anterior chamber angle (ACA) parameters and to assess association of these parameters with age in Asian subjects. Methods:, Four hundred and thirty-nine consecutive Korean subjects aged from 30 to 89 were enrolled from a university clinic. All participants were scanned using anterior segment optical coherence tomography (AS-OCT, Visante, version 2.0). We measured ACA parameters such as anterior chamber depth (ACD), angle opening distance at 500 and 750 ,m (AOD500,750), angle recess area at 500 and 750 ,m (ARA500,750), trabecular iris space area at 500 and 750 ,m (TISA500,750), and determined age-related changes in these parameters with use of a linear mixed effect model that adjusted for gender, axial length, intraocular pressure, and keratometry data. Slopes of ACA parameters as a function of age were determined. For various AS-OCT parameters, the normalized slope was calculated by dividing the slope by the mean value. Results:, All analysed ACA parameters decreased with age in both nasal and temporal quadrants. Axial length and keratometry data were significant covariates for ACA changes. The slopes of ACD were ,0.02396 mm/year, AOD500, ARA500, and TISA500 measured at the temporal angle were ,0.00634 mm/year, ,0.0019 mm2/year, and ,0.00177 mm2/year, respectively. There was no age-dependent difference in central corneal thickness (p value; 0.4597) Based on the normalized slopes, the AOD showed the steepest slope at both temporal and nasal sectors. Conclusion:, All ACA parameters assessed by AS-OCT, which accounted for other ocular biometric parameters, showed significant negative slopes with increasing age. These results should be considered when assessing changes in the anterior chamber over time. [source] 1225: Anaesthesia in cataract surgeryACTA OPHTHALMOLOGICA, Issue 2010P BODROGI I would like to give a review of anaesthetic methods used in cataract surgery. Retrobulbar (RB) anaesthesia via injection provides not only painlessness, but also akinesia and cuts off autonomic reflexes. Although unfortunatelly it has many possible sideeffects, like perforation of the globe, retrobulbar haemorrhage or injury of the optic nerve, it is still widely used. Parabulbar (PB) anaesthesia was introduced to eliminate traumatic sideeffects of RB, but it did not fulfill all expectations. There are also subconjunctival and sub-Tenon anaesthesia, the latter also results in akinesia. Since the introduction of phacoemulsification topical anaesthesia has become current. Due to the gentle surgical technique, if the wound is corneal and there is no severe fluctuation of depth of the anterior chamber, it can provide sufficient anaesthesia. They apply it in form of drops, gel or special sponge. It can be replenished with intracameral Lidocain. Before surgery it is widely used to apply systemic sedatives, which helps to attenuate the patients' angst because of surgery. Supporting attitude of medical crew and positive verbal communication is also beneficial at this task. General anaesthesia is still the only possibility used in cataract surgery of children and other people unable to cooperate. [source] 1262: Symptoms and signs of anterior uveitisACTA OPHTHALMOLOGICA, Issue 2010I TUGAL-TUTKUN Purpose Based on the anatomic classification of uveitis, iritis and iridocyclitis are classified as anterior uveitis. Methods Symptoms and signs of anterior uveitis will be presented Results Patients with acute anterior uveitis typically present with red eyes, photophobia, ocular pain, and sometimes visual blurring. In chronic anterior uveitis, onset is usually insidious and patients may be asymptomatic until the development of complications. Ciliary injection, endothelial dusting or fine keratic precipitates (KPs), cells and flare in the anterior chamber with or without hypopyon formation or fibrinous exudate are the typical findings of alternating unilateral acute nongranulomatous anterior uveitis which is most commonly seen in association with HLA-B27 antigen and spondyloarthropaties. Medium-size KPs or large mutton-fat KPs, chronic flare, Koeppe and Busacca nodules of the iris, peripheral anterior synechiae and broad-based posterior synechiae are the typical findings of granulomatous anterior uveitis which is often chronic. Viral anterior uveitis is characterized by unilateral recurrent episodes of anterior uveitis characterized by endotheliitis, elevated intraocular pressure, and patchy or sectoral iris atrophy. JIA-associated anterior uveitis is typically a bilateral nongranulomatous chronic anterior uveitis often complicated by band keratopathy, seclusion of the pupil, and cataract. Conclusion Symptoms and signs in anterior uveitis vary depending on the acute or chronic, ganulomatous or nongranulomatous nature of the disease. Specific anterior uveitic entities are characterized by a distinct constellation of ocular signs. [source] 1235: How to prevent postoperative complications?ACTA OPHTHALMOLOGICA, Issue 2010C CREUZOT Purpose Retinal detachment can lead to early and delayed post-operative complications. The purpose of the course is to present the different complications following retinal detachment surgery with their appropriate treatments. Methods The postoperative complications will be divided according to the presentation of the patient (ie inflamed, painful eye or white painless eye) with or without visual loss.Then, IOP measurement and the results from slit lamp and fundus exam will provide us with the main signs useful for diagnosis. Results With a painful red eye, the main severe diagnoses will be the different causes of increased IOP and endophthalmitis. The main cause of increased ocular pressure is related to the internal tamponade used during surgery (gas or silicone). However, the diagnosis of massive passage of silicone in the anterior chamber should be difficult. Hyphema or cataract due to gas should prevent us from a good fundus examination. Conclusion This course will mainly focus on the different early and more delayed complications after retinal detachment surgery and will try to give some rules to decrease this risk. [source] 3352: The effects of high altitude on central corneal thicknessACTA OPHTHALMOLOGICA, Issue 2010H BASMAK Purpose A large number of people are exposed to long-term hypobaric hypoxic conditions via mountaineering, skiing and trekking. Other people such as aviators and high-altitude parachutists are exposed to short-term hypobaric hypoxic conditions. It is known that hypobaric conditions alter physiological and morphological status of the eye including the central corneal thickness (CCT). Our aim is to review the results of the influences of high altitude on CCT. We will also add our experience on the influences of short-term hypobaric hypoxia on CCT. Methods Reports covering this topic will be discussed. The possible mechanisms for the alterations in CCT will be included. Hypobaric hypoxic conditions simulate high altitudinal environments, which was the basis of our study covering 70 eyes of 35 healthy men exposed to hypobaric hypoxic condition. We measured the CCT via ultrasound pachmetry at local ground (792 m above sea level) and then during short-term hypobaric hypoxic exposure (equivalent 9144 m above). Results CCT has been found to be increased at high altitudes. We also found that hypobaric hypoxic condition increased the CCT significantly. The mechanism of increased CCT is not clear, although the alterations in corneal endothelial cells function seem to be the main explanation. Systemic delivery of oxygen to the anterior chamber can possibly be an important contributing factor based on a recent study. Conclusion CCT has been reported to be increased at high altitude. The possible underlying mechanisms are altered endothelial function and metabolic activity. [source] 2127: Ghrelin concentration in the aqueous humour and plasma in open angle glaucoma patientsACTA OPHTHALMOLOGICA, Issue 2010A KATSANOS Purpose Ghrelin is a peptide hormone that exerts metabolic and smooth muscle-relaxant effects in ocular tissues. The aim of this study was to compare aqueous humor and plasma levels of ghrelin in patients with open angle glaucoma (OAG) and controls. Methods Twenty four OAG, including 7 pseudoexfoliation (PXG) and 17 primary open-angle glaucoma (POAG) patients, and 30 controls were included. All participants were patients scheduled for cataract or glaucoma surgery. Patients with other concomitant ocular disease, previous ocular surgery or diabetes were excluded. Blood samples were collected before cataract surgery. Aqueous humor was aspirated from the anterior chamber through a paracentesis with a 27 G needle under sterile conditions. Ghrelin levels in both samples were measured quantitatively with commercially available Radioimmunoassay (RIA) kits. Results Mean±SD age was 71.0±9.3 and 69.6±6.6 years in the OAG and control groups, respectively (p=0.6). Plasma levels of ghrelin were 495.6±157.7 pg/ml in the OAG and 482.2±125.4 pg/ml in the control group, respectively (Mann-Whitney test, p=0.9). Aqueous humor levels of ghrelin were 85.5±15.4 pg/ml and 123.4 ±25.5 pg/ml in the OAG and control groups, respectively (Mann-Whitney test, p<0.01). The ratio of plasma/aqueous concentration in ghrelin was higher in the OAG versus the control group (5.82± 1.94 versus 4.00±1.04, Mann-Whitney test, p<0.01). There was no difference neither in plasma nor in aqueous humor levels of ghrelin between POAG and PXG patients (p>0.5). Conclusion Aqueous humor levels of ghrelin were significantly lower in OAG patients. This difference may manifest a role of ghrelin in the disease process or a consequence of antiglaucoma treatment. [source] 2145: Descemet“s membrane detachment 16 years after PK and 10 months after phacoACTA OPHTHALMOLOGICA, Issue 2010JO FERNANDEZ MENDY Purpose The purpose of this paper is to present an unusual case of DMD and analyze this complication Methods A 57-year-old woman, who had bilateral keratoconus, underwent three penetrating keratoplasties (PK) on her RE in 1981, 1993 and 1995 resulting in ptisis bulbi. In her LE she underwent two PK (1981, 1994) follow by arcuate incisions (1995) and an uneventful phacoemulsification in 2007. 10 months after cataract surgery, she begun with blurred vision, the BCVA was 20/400 and was seen by 3 ophthalmologists who made the diagnosis of endothelial failure and suggested a new PK or a DSAEK. We performed an Optical Coherence Tomography, diagnosing a complete Descemet“s membrane detachment (DMD). An intracameral gas injection of C3F8 at 16% was performed in the operating room, and the patient was instructed to maintain a supine position. After 24 hours VA improved to 20/80 and after 72 hours 20/30 UCVA. A small bubble was present in the anterior chamber for more than 3 weeks. One month later she achieved 20/20 with Contact Lens. During the first year after reattachment it was necessary to change the CL due to an increasing with the rule astigmatism from 3D to 5D. Results Two years after gas injection BSVA is 20/25 because she is no longer using CL, Descemet“s membrane still remains well attached, even thought we realized that there was a trend to steepen the vertical meridian due to the widening of a nasal arcuate incision, that we think was the origin of the DMD. Conclusion DMD is a rare complication of Phacoemulsification, seen immediately after the surgery. So far there has not reported any complete DMD after phaco after PK. We think that it is mandatory to perform a corneal OCT in all cases of PK and stromal edema; it could probably be a DMD. [source] Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot studyACTA OPHTHALMOLOGICA, Issue 1 2010Dimitris Papaconstantinou Abstract. Purpose:, To present the preliminary results of our study comparing the outcomes of trabeculectomy with or without OloGen implant in patients requiring glaucoma surgery for uncontrolled intraocular pressure (IOP). Methods:, Forty eyes of 40 patients were assigned randomly to undergo trabeculectomy either with OloGen implant (study group) or without implant (control group). Preoperative data included age, gender, type of glaucoma, IOP and number of preoperative glaucoma medications. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Each patient was followed up for at least 6 months. Results:, There were no significant differences between the groups in terms of age, gender, type of glaucoma, preoperative IOP and number of antiglaucoma medications. Mean IOPs for both groups were significantly lower than preoperative levels at all intervals (P < 0.05) The number of glaucoma medications used dropped from a preoperative mean of 3.5 ± 0.7 to a 6-month postoperative mean of 0.3 ± 0.7 (P < 0.001) in the study group and from 3.7 ± 0.4 to 0.5 ± 1.1 (P < 0.001) in the control group. No statistically significant differences between the two groups were observed in terms of postoperative complications. Conclusion:, In this pilot study it appears that trabeculectomy with OloGen does not seem to offer any significant advantages compared with trabeculectomy alone. Additionally, even though there were no statistical differences between the two groups as far as complications were concerned, one eye from the study group developed endophthalmitis 10 days after surgery and two eyes presented with positive Seidel test and flat anterior chamber and required additional suturing. Studies with larger numbers of patients and longer follow-ups are required to confirm these findings and to examine the safety and long-term outcomes of trabeculectomy with OloGen. [source] Animal studies for the prevention of endophthalmitisACTA OPHTHALMOLOGICA, Issue 2009RP KOWALSKI Topical anti-infectives are commonly used to prevent post-surgical endophthalmitis. Animal models can be used for the development and selection of topical anti-infectives for optimizing ocular surgical prophylaxis. The primary outcome measures for providing prophylactic efficiency are antibacterial efficacy and anti-infective penetration into the anterior chamber. This curreent presentation will focus on a rabbit prevention of endophthalmitis model. Publish data will be presented detailing clinical correlation and limitations of the models. [source] Gene therapy for posterior uveitisACTA OPHTHALMOLOGICA, Issue 2009AD DICK Purpose To investigate the role of gene therapy incorporating release of immunomodulatory cytokines in animal models of intraocular inflammation Methods By inoculating with either AAV or lente viruses incorporating genes for IL-1RA or IL-10 into either the anterior chamber or subretinally we onserved the ability to suppress either endotoxin induced uveitis (EIU) or experimental autoimmiune uveoretinitis (EAU). Results Anterior chamber inoculation with lente-IL-10 or IL-1RA successfully suppresses inflammation and protein exudation into the eye during the course of EIU. Subretinal injection of AAV-IL-10 suppresses EAU. The extent of local macrophage activation is also suppressed as there is marked reduction in nitrotyrosine expression within the retina. Conclusion Gene therapy with immunomodulatory cytokines offers a potential to suppress active inflammatory processes within the retina. Mechanisms will be discussed in the talk in relation to macrophage activation and restoring myeloid cell (microgolial) homeostasis within the retina. [source] Help, I've been too successful: postoperative hypotonyACTA OPHTHALMOLOGICA, Issue 2009T ZEYEN Purpose To give an overview of the etiology and treatment of hypotony post-trabeculectomy. Methods Postoperative hypotony is most commonly caused by either overfiltration or bleb leakage. This condition can lead to a flat anterior chamber, hypotony maculopathy, choroidal detachment, and cataract. Results Possible strategies to decrease overfiltration and heal bleb leaks will be highlighted. We will review when and how to refill the anterior chamber, and discuss the proper timing and technique to treat choroidal detachments. Finally, the indications, pros and cons of cataract surgery after trabeculectomy will be discussed. Conclusion This presentation will give guidance on how to diagnose and treat hypotony after trabeculectomy. [source] Tibial Bone KPro technique and long term resultsACTA OPHTHALMOLOGICA, Issue 2009J TEMPRANO The operation is performed in three stages. The first stage consists in preparing the eye to receive and maintain the keratoprosthesis. For this purpose the anterior surface of the eye is cleaned and regularized, eliminating fibrous tissue and the entire epithelium. Subsequently we obtain a 2 x 3 cm graft of buccal mucosa from the inferior lip comprising the entire mucosal and submucosal thickness. The graft is sutured to cover the anterior pole of the eye to promote revitalization. The second stage consists in preparing the keratoprosthesis. A 10 mm disk of tibial bone from the superior part of the medial face of the tibia is obtained using a crown drill. The posterior part of the piece of bone obtained is then cut with a chisel to obtain a thickness of 3 mm. Subsequently the obtained disk of bone is cleaned and a central opening of 3.5 mm is performed to introduce in this opening a PMMA optic cylinder, 9 mm in length, 3.5 mm in diameter in its narrow portion, 4 mm in the wider portion. Fixation is achieved with cyanoacrylate. This is left to dry and then it is introduced into a palpebral pocket of the inferior lid of the patient. The pocket is closed with sutures and the piece is left in place for three months. For the third stage we remove the keratoprosthesis device from the palpebral pocket and if it is found to be in perfect conditions we dissect the buccal mucous membrane which is covering the cornea and perform a central window with a 4.5 mm trephine to remove the transparent or cataractous lens and perform a total iridectomy. The posterior portion of the optic cylinder is introduced into the anterior chamber. The prosthesis is sutured to the anterior pole of the eye with non-absorbible sutures. Finally the buccal mucosa is replaced, covering the entire area. One point of blepharorraphy is applied. Long term results. We started to use this technique in 1988 and after 21 years of experience we have 80% of anatomically perfect results. In 20 % of the cases the prosthesis extruded due to total or partial resorption of the bone. It has to be emphasized that these were cases without any other possibility of treatment. We did 143 cases during these years. The longest follow-up of a prosthesis "in situ" is 19 years. The earliest extrusion was after one year. The complications are the same as for OOKP (glaucoma, retinal detachment, vitritis, extrusion) The functional results depend on the conditions of the retina and the optic nerve. There were many cases with 20/20 vision. The mean value of retention of the prosthesis is 15 years. [source] A new technique of anterior TAP enhances the positivity of CMV by PCR in hypertensives anterior uveitisACTA OPHTHALMOLOGICA, Issue 2009P KOCH Purpose Anterior uveitis can be severely disabling. Especially, hypertensives anterior uveitis can lead to a decrease in visual acuity, posterior synechiaes, cataract, glaucoma, etc. Diagnosis is frequently complex. Two main aetiologies are retained: non infectious (auto-immunes) and infectious forms. Amongst the lasts, various aetiologies are possible. Viral anterior uveitis remained difficult to diagnose for a long time. However, since the emergence of the polymerase chain reaction (PCR), the diagnosis is definitely easier. Nevertheless, anterior TAP result is determined by different limitations including the puncture technique, the PCR primers used, and of course the investigated virus. Methods We hereby propose a new technique of anterior TAP that allowed us to increase our PCR results in CMV anterior uveitis. Two samples were obtained: firstly, a conventional anterior TAP was realised; followed by a rinsing of the anterior chamber with saline solution. A Goldman-Witmer index for rubeola was performed in the first sample. Both samples were examined for viral PCR (HSV1, 2, VZV, CMV, EBV, Rubeola) Results We did not found any side effect of the technique used by comparison with normal anterior TAP. Diagnosis was obtained in 20 of the 35 eyes tested. Rubeola diagnosis was obtained in 11/20 eyes, VZV in 1/20, HSV1 in 4/20, and CMV in 4/20. Intriguingly, CMV diagnosis was obtained in three cases only in the second syringe and not in the first Conclusion We have, to date, detected 4 cases of CMV anterior uveitis in a cohort of 35 patients with anterior uveitis. We did not meet any complication but obtained interesting results concerning CMV diagnosis, using a rinsing of the anterior chamber (second syringe). [source] Slitlamp integrated OCT, what you can see, is what you can scanACTA OPHTHALMOLOGICA, Issue 2009FD VERBRAAK Purpose To present results of OCT images captured of the posterior and anterior segment of the eye using the SLSCAN-1, a new FD-OCT device integrated into a slit lamp. Methods Patients, seen in the outpatient clinic of the Academic Medical Center, were scanned with the SLSCAN-1, a newly developed OCT scanning device, integrated into a common slit lamp (figure 1). The OCT is a Fourier Domain OCT system (SLD light source, central wavelength 830 nm, bandwidth 30 nm, 1024 pixel CCD camera, scan speed 5k A-scans per second, 1024 A-scans per B-scan). The posterior segment scans have been captured using a standard indirect ophthalmic lens (Volk). A color fundus photography of the observed area is made at the same time (Topcon camera DC1, resolution = 3.24 Mp). Results For posterior segment imaging, the flexible optical arrangement of the slit lamp and the hand-held lens (Volk), allows the user to scan large areas of the retina (>45 degrees), depending on the pupil size of the patient. In all patients the macula and optic disk could be visualized without any difficulty. In the anterior segment mode, the SLSCAN-1 allows imaging of the cornea, anterior chamber, iris and parts of the lens. Conclusion The images made by the SLSCAN-, new slit lamp integrated FD-OCT, could be very useful to examine patients directly, both posterior and anterior, during regular slit lamp examinations. Commercial interest [source] Factors affecting ocular rigidity in normal human eyesACTA OPHTHALMOLOGICA, Issue 2009AI DASTIRIDOU Purpose To measure the ocular rigidity coefficient and evaluate its relation with axial length (AL), age and mean systemic blood pressure (SBP). Methods Sixty three patients (63 eyes) undergoing cataract surgery, with different refractive errors and no ocular or systemic pathology were enrolled in this study. An invasive, computer controlled device comprising a microdosimetric pump and a pressure sensor, is connected to the anterior chamber under topical anaesthesia with drops. The system is used to raise the intraocular pressure (IOP) from 15 to 40mmHg, by infusing the eye with a saline solution. After each 4 ul infusion step, the IOP is continuously recorded for 2 seconds. From an initial level of 40mmHg an IOP decay curve of 1 minute is obtained. SBP and pulse rate are measured during the procedure. The rigidity coefficient is calculated by an exponential fit to the pressure volume data after correction for outflow. The study was approved by the Institutional Board and performed under the patient's informed consent. Results Mean AL was 24.8 (range 21.2-32.5). Mean age and SBP was 59 (12) years and 93.7 (10.5) mmHg respectively. The mean ocular rigidity coefficient was 0.021 (0.005) ul-1. Increasing axial length is associated with a decrease in the rigidity coefficient (r=-0.61, p<0.01). A positive correlation between the rigidity coefficient and age of the patients is found (r=0.31, p=0.01), whereas similar findings were not observed for SBP (p>0.05). Conclusion This manonetric approach of measuring ocular rigidity provides a normative database of this parameter in living human eyes. Axial length and age influence ocular rigidity. These results may have implications on tonography and ocular pulse studies. [source] Microplasmin improves surgical outcome in a rabbit model for trabeculectomyACTA OPHTHALMOLOGICA, Issue 2009E VANDEWALLE Purpose This study was designed to study the efficacy and safety of Microplasmin as an anti-scarring agent after trabeculectomy in a rabbit model. Methods The effect of Microplasmin was investigated in vivo in a rabbit model for glaucoma surgery. Clinical outcome measures were intra-ocular pressure, bleb area and survival, side effects on slit lamp examination. Moreover, (immuno-) histochemical analysis of the eyes was performed, with quantification of inflammation (CD 45) and collagen deposition (Trichrome and Sirius Red). In the first experiment (n=10), Microplasmin anterior chamber injection was compared to placebo injection. In the second experiment (n=3), topical Microplasmin drops were compared to placebo drops. In the third experiment (n=5) the combination of Microplasmin anterior chamber injection and topical drops was compared to placebo injection and drops. All experiments were conducted in a masked observator way. Results Microplasmin significantly augmented the bleb area and survival in a rabbit model of trabeculectomy after a single anterior chamber injection or combination therapy (injection combined with drops) compared to control. Collagen deposition was borderline reduced after Microplasmin administration compared to control. No significant changes in inflammation were noticed in the anterior chamber or in the conjunctiva. Conclusion Microplasmin single injection or combination with postoperative drops improved the outcome after trabeculectomy. In a rabbit model, larger blebs were produced for a longer period compared to control, and collagen deposition tended to decrease in this small series. [source] Inflammation assessment after selective laser trabeculoplasty (SLT) treatmentACTA OPHTHALMOLOGICA, Issue 2009M AYALA Purpose Glaucoma is a progressive neuropathy, reducing intraocular pressure (IOP) seems to be the only treatment to stop progression in glaucoma. There are several methods to reduce IOP: medical treatment, laser and surgery. Selective Laser Trabeculoplasty (SLT) is a new treatment alternative. SLT selectively targets the pigmented cells of the trabecular meshwork without causing thermal or collateral damage to the surroundings structures. The aim of the present study was to assess inflammation after SLT treatment. Methods 40 patients (80 eyes) were included in the study. Inclusion criteria: Glaucoma (POAG, pigmentary and pseudoexfoliative glaucoma)/ OHT patients that will be treated with SLT in just one eye, both with and without eye-drops. Exclusion criteria: patients suffering from ocular or systemic inflammatory diseases or treated with cortisone or immunosuppressive drugs. Inflammation was measured in 2 different ways: 1) clinically with a slit lamp and classified 0-4; 2) with a "Laser flare meter (Kowa FM 500)". Measurements were done before, 2 hours after, 1 week and 1 month after SLT treatement, both eyes were evaluated. IOP was also checked in the same way. SLT treatment was performed in 90° with the SLT Solo Ellex laser. Results inflammation before and after SLT showed no significant difference measured both clinically with slit lamp and objectively with the laser flare meter. No inflammation was found in the untreated eyes. No IOP peaks after SLT treatment were found. Conclusion SLT treatment seems not to induce inflammation in the anterior chamber when 90° were treated. SLT treatment might be considered as a first choice treatment against high intraocular pressure. [source] Viscoanaesthesia in cataract surgery: a prospective, randomized clinical trialACTA OPHTHALMOLOGICA, Issue 4 2009Juha Välimäki Abstract. Purpose:, We aimed to compare viscoanaesthesia (VisThesia) with intracameral lidocaine in cataract surgery carried out under topical anaesthesia. Methods:, In this prospective study 98 patients were randomly assigned to receive VisThesia (group 1, n = 49) or 0.5 cc of 1% unpreserved lidocaine (group 2, n = 49). All surgery was carried out by one surgeon using clear corneal technique. Pachymetry, the status of the cornea and anterior chamber, and intraocular pressure (IOP) were checked pre- and postoperatively. Results:, Mean pain scores were 0.12 (maximum: 3) in group 1 and 0.37 in group 2; the difference between the groups was not statistically significant (95% confidence interval [CI] 0.003,0.487; p = 0.05). A total of 48 patients in group 1 (98%) and 49 in group 2 (100%) reported no discomfort or only mild discomfort. No significant differences in flare and cells in the anterior chamber or IOP were found between the two study groups. There was a significantly greater frequency of corneal oedema in group 1 (p = 0.001). Postoperative central corneal thickness values were also significantly higher in group 1 (95% CI 11.64,57.24; p = 0.003). Conclusions:, Results suggest that viscoanaesthesia provides a level of comfort during cataract surgery under topical anaesthesia similar to that facilitated by intracameral lidocaine. However, patients who are given viscoanaesthesia may have increased risk for postoperative corneal oedema. [source] Effect of bromfenac ophthalmic solution on ocular inflammation following cataract surgeryACTA OPHTHALMOLOGICA, Issue 3 2009Masaru Miyanaga Abstract. Purpose:, This study compared the post-cataract surgery anti-inflammatory effects of topical treatment with 0.1% bromfenac, 0.1% betamethasone or both on postoperative anterior chamber inflammation and corneal swelling. Methods:, Seventy-two patients with no eye disease other than cataract were enrolled in a prospective, randomized study to undergo phacoemulsification combined with intraocular lens implantation. After cataract surgery, patients were randomized to treatment with bromfenac, betamethasone or both agents. Twenty-five eyes were assigned to bromfenac, 23 to betamethasone and 24 to the combined treatment group. Inflammatory reactions in the anterior chamber were measured with laser flare photometry preoperatively and at 1 and 3 days, 1 and 2 weeks, and 1 and 2 months postoperatively. Intraocular pressure (IOP) and corneal thickness were measured at the same time-points. Best corrected visual acuity (BCVA) was measured preoperatively and at 2 days, 1 and 2 weeks, and 1 and 2 months postoperatively. Specular microscope endothelial photography of the central region of the cornea was performed preoperatively and at 3 months after surgery. Results:, There were no significant differences among the bromfenac, betamethasone and combined treatment groups in BCVA, IOP, aqueous flare or corneal thickness. Cystoid macular oedema was present in one eye treated with betamethasone. Conclusions:, There were no significant differences in anti-inflammatory effects among the three treatments. These findings suggest that bromfenac is as effective as betamethasone in minimizing inflammatory reactions after cataract surgery. [source] Longterm results of deep lamellar keratoplasty using grafts with endotheliumACTA OPHTHALMOLOGICA, Issue 1 2008Shiro Higaki Abstract. Purpose:, To report the longterm results of deep lamellar keratoplasty (DLK) using grafts with their own endothelia. Methods:, Fourteen eyes of 14 patients underwent DLK using grafts with endothelium. The average follow-up was approximately 80.0 months. Preoperative diagnoses included: corneal leukoma (five eyes); gelatinous drop-like corneal dystrophy (three eyes); Avellino corneal dystrophy (two eyes); corneal perforation (two eyes); corneal mucopolysaccharidosis (one eye), and keratoconus (one eye). Results:, Corrected visual acuity was improved in 13 eyes (93%), but ruptures of Descemet's membrane occurred in six eyes (43%) and a double anterior chamber was found in five eyes (36%) postoperatively. Despite this, all grafts remained clear as a result of their functioning endothelia. Conclusions:, Deep lamellar keratoplasty using a graft with its own endothelium is a safe and valuable procedure with flexibility and feasibility that should suit corneal surgeons of all levels. [source] High Order Aberrations of the eye implanted the Verisyse® iris-claw intraocular lensACTA OPHTHALMOLOGICA, Issue 2007JJ GICQUEL Purpose: To investigate the influence of the secondary implantation site of the Verisyse® iris-claw intraocular lens (IOL) on high order aberrations (HOAs) using wavefront analysis in aphakic patients. Methods: Twenty aphakic patients (20 eyes) who had complicated phacoemulsification, leaving no capsular support, but good iris support and clear unwounded cornea implantated with the aphakic Verisyse®(AMO) intraocular lens site either implanted retropupilarely or over the iris. Wavefront aberrations were measured using the IRX3 Hartmann-Shack aberrometer at 4 mm pupil aperture diameter. Results: Nine patients were implanted in the anterior chamber versus 11 who had the IOL clipped behind the iris. Best corrected visual acuity was significantly higher and HOAs were significantly lower in the retropupilarely implanted group. Conclusions: In addition to being atraumatic, the Verisyse® intraocular lens implanted behind the iris may restore vision in the absence of capsular support in a more physiological way than when fixated over the iris. [source] Simultaneous quantification of 17 immune mediators in aqueous humour from patients with corneal rejectionACTA OPHTHALMOLOGICA, Issue 6 2006Mikkel Funding Abstract. Purpose:, To simultaneously quantitate and compare the concentrations of 17 immune mediators: (1) the cytokines interleukin-1,, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-12p70, IL-13, IL-17, tumour necrosis factor-,, interferon-,; (2) the growth factors granulocyte,monocyte colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF), and (3) the chemokines CXCL-8, monocyte chemoattractant protein-1, and macrophage inflammatory protein-1, in aqueous humour from patients with corneal rejection and patients with a non-inflammatory condition in the anterior chamber. Methods:, Aqueous humour was obtained by paracentesis of the anterior chamber in 14 patients with corneal rejection, three patients with cataract and six patients with Fuchs' endothelial dystrophy. Simultaneous quantitation of 17 mediators in 25 µl aqueous humour from each patient was performed by employing a highly sensitive Luminex® 100 multiplex array assay. Results:, All 17 immune mediators were detected in aqueous humour from rejection patients. The ranges of the immune mediators were determined. The immune mediators were significantly increased in aqueous humour from rejection patients compared with that from other patients. Conclusions:, The Luminex 100 multiplex array assay is very efficient in simultaneous quantitation of multiple immune mediators in small volumes of aqueous humour. A total of 17 immune mediators were increased in aqueous humour from rejection patients. This underlines the complex immunological interactions of the rejection process. [source] Effect of 0.03% tacrolimus ointment on conjunctival cytology in patients with severe atopic blepharoconjunctivitis: a retrospective studyACTA OPHTHALMOLOGICA, Issue 5 2006Hannele M. Virtanen Abstract. Purpose:, To evaluate the efficacy and effect of tacrolimus ointment on conjunctival cytology in patients with atopic blepharoconjunctivitis or keratoconjunctivitis. Methods:, Ten patients with severe atopic blepharoconjunctivitis treated with 0.03% tacrolimus ointment once daily as an intermittent treatment were analysed retrospectively. The main outcome measures were clinical response to topical tacrolimus, adverse events and changes in the inflammatory cells obtained from conjunctival brush samples. Results:, Marked clinical responses in blepharitis and conjunctivitis symptoms were seen after a mean follow-up time of 6 weeks. Clinical scores decreased by 67% in blepharitis and 74% in conjunctivitis symptoms. No severe adverse events or signs of immunosuppression such as herpes simplex infections occurred. No significant changes occurred in visual acuity, refraction, anterior chamber, retina or intraocular pressure. Median decreases were 85% (p =0.01) in conjunctival eosinophils, 50% (p = 0.01) in neutrophils and 58% (p = 0.02) in lymphocytes. Conclusions:, Tacrolimus ointment is potentially a safe and effective treatment for atopic blepharoconjunctivitis. Regular treatment of the eyelids once daily may also lead to clinical and cytological improvement of the conjunctivitis. [source] A new technique for removing the inner wall of Schlemm's canal using cyanoacrylateACTA OPHTHALMOLOGICA, Issue 2 2003Shigeta Naruse Abstract. Purpose:, To introduce a new technique for removing the inner wall of Schlemm's canal using cyanoacrylate. Methods:, Two donor eyes were used in this study. A limbal-based scleral flap was dissected. The external wall of Schlemm's canal was opened and the inner wall of Schlemm's canal was exposed. Ethyl-2-cyanoacrylate was applied uniformly to the inner wall. After it had solidified, it was removed with fine forceps. The operated sites were then studied by light microscopy. Results:, After cyanoacrylate removal, the aqueous humour was seen percolating through the thin remaining trabecular meshwork. Histopathological findings at the operated sites revealed that the lining of the Schlemm's endothelial cells was irregular. Endothelial cell nuclei were rarely seen along the canal wall. Microperforation to the anterior chamber was not seen. Conclusion:, This new technique is potentially a safer method for removing the inner wall of Schlemm's canal than the conventional method. [source] | ||||||||||