Szemészet, 2016 (153. évfolyam, 1-4. szám)
2016-06-01 - Supplementum
Kongresszusi összefoglalók Examination of keratocyte density with in vivo confocal microscopy after keratoplasty Zsuzsa Fiaskó, András Berta, László Módis Department of Ophthalmology, Debrecen Medical University Center Purpose: Our aim was the comparative examination of the cornea of patients who underwent penetrating keratoplasty either with manual or femtosecond laser-assisted technique using confocal microscopy. Method: 19 eyes (8 left, 11 right) of 18 patients (10 women, 8 men) were examined with in vivo contact confocal laser microscopy. (HRT 111/Rostock Cornea Module, Heidelberg, Germany). Among the patients examined there were 12 cases with manual (Moria vacuum trepan, Antony, France) penetrating keratoplasty (PKP, mean age: 45-58±19-32 years) and 7 cases of femtosecond laser-assisted keratoplasty (FLAK, mean age: 50.25±22.29 years). The post-treatment of patients was conducted in the same way, including local corticosteroid therapy for half a year. Keratocyte cell density (KCD) was determined after using confocal microscopy. The examinations were done on both the anterior and posterior stroma of the cornea as keratocyte cel! density is different in both parts even in normal cases. The time between the examination and the operation in the study groups were (in months): PKP 31.71±16.63, FLAK 29'.46±10.48. The statistical analysis was done with Mann-Whitney test. Results: In every case the transplant was transparent and dean at the end of the follow-up period. The keratocyte cell density found in the anterior stroma was: 717-65±40.32 cells/mm2 (PKP), 833.48±79-13 cells/mm2 (FLAK). The cell density counted in the posterior stroma was: 431.76 ±23.23 cells/mm2 (PKP), 471-23 ±24.69 cells/mm2 (FLAK). There was no significant difference between the KCD values in the anterior (p=0.26) and the posterior stroma (p=0.20) of the two surgical groups. No inflammatory cell infiltration was observed in either group. Conclusion: There was no difference between the manual and the femtosecond laser-assisted keratoplasty in the keratocyte densities which may refer to the fact that repopulation of keratocytes and wound healing happen similarly. E31 Lamellaris és perforáló keratoplasztika iridocornealisendothelialis szindrómában Füst Ágnes, Imre László Semmelweis Egyetem, Szemészeti Klinika, Budapest Az iridocomealis-endothelialis (ICE) szindróma fiatal felnőttkorban kezdődő, általában féloldali, progresszív, nem öröklődő szembetegség. Fő jellemzői az iris progresszív atrófiája illetve iris-naevusok, kóros cornealis endothelium és a perifériás elülső synechiák. Következménye a nehezen kezelhető zöld hályog és a szaruhártya dekompenzálódása. Négy ICE-szindrómás beteg (két férfi, két nő) egy-egy szemén végeztünk szaruhártya-átültetést. Két betegnél - akiknél a szemnyomást Ahmed-sönt tartja egyensúlyban - hátulsó lamelláris keratoplasztika (Descemet-stripping automated endothelial keratoplasty, DSAEK) történt, az egyik esetben phacoemulsificatióval kombinálva. A két másik betegnél az igen kiterjedt összenövések miatt a perforáló keratoplasztikát (PKP) választottuk, egyik esetben a szaruhártya műtétét itt is szürkehályog-letávolítással kombináltuk. A nyomon követési idő I9±l2 hónap volt. A perifériás elülső synechiák nehezítették különösen a DSAEK-műtét kivitelezését, azonban a műtétet mindkét esetben sikeresen el lehetett végezni, a hátsó cornealamellák feltapadtak a helyükre. A négyből három szemen a szaruhártya fel tisztult, egyik DSAEK-s esetünkben azonban primer graftelégtelenséget tapasztaltunk. Az egyik PKP-s esetben a szemnyomás dekompenzálódása miatt ciklofotokoagulációt végeztünk. Betegeinknél mind a lamelláris, mind a perforáló keratoplastica alkalmas volt az ICE-syndroma részeként kialakult szaruhártya-dekompenzálódás műtéti kezelésére. Lamellar and perforating keratoplasty in iridocorneal-endothelial syndrome Ágnes Füst, László Imre Semmelweis University, Budapest, Department of Ophthalmology, Budapest Iridocorneal-endothelial (ICE) syndrome is a generally unilateral, nonfamiliar, progressive ocular disease beginning in young adulthood. Mean features are progressive atrophy or naevi of the iris, pathological corneal endothelium and peripheral anterior synechiae. The consequences are glaucoma which is difficult to treat and decompensation of the cornea. Keratoplasty was performed on four eyes of 4 patients (2 female, 2 male) with ICE syndrome. Descemet-stripping automated endothelial keratoplasty (DSAEK) was done in two patients (in whom the intraocular pressure was compensated with Ahmed-shunt), in one of them the surgery was combined with phacoemulsification. Perforating keratoplasty (PKP) was the choice in the two other patients because of the widespread anterior synechiae, in one case it was also combined with cataract extraction. Follow-up time was 19±12 months. The peripheral anterior synechiae made the DSAEK surgery technically difficult, however, it could be performed successfully in both cases, the posterior lamella attached to its place. In three of the four eyes the cornea cleared up, but in one DSAEK case primary graft failure was experienced. In one PKP case cyclophotocoagulation was performed. In our patients both the lamellar and the perforating keratoplasty was appropriate for the surgical treatment of corneal decompensation due to ICE syndrome. / V ; Á0 ;
