Excimer laser-assisted DALK: a case report from the Homburg Keratoconus Center (HKC)

Indikationen Ziel der Excimerlaser-gestützten DALK (Excimer-DALK) ist, wie bei der mechanischen DALK, die Behandlung von Keratektasien (Keratokonus und pellucide marginale Degeneration), stromalen Narben oder stromalen Hornhautdystrophien. Voraussetzung für die Operation ist die Abwesenheit von (prä)descemetalen Narben sowie ein gesundes Endothel. Operationstechnik Nach der Excimerlaser-gestützten Trepanation auf 80 % der kornealen Dicke an der Trepanationsstelle, einer intrastromalen Lufteingabe (sog. „Big-Bubble“) sowie einer lamellären Hornhautpräparation erfolgt eine lamelläre anteriore Transplantation des endothelfreien Spendergewebes. Diese Technik kombiniert die Vorteile einer DALK und einer Excimerlaser-Trepanation. Wir beschreiben die Schritte einer Excimer-DALK aus unserem Homburger Keratokonus Center (HKC). Schlussfolgerungen Die Excimer-DALK stellt bei Patienten mit gutem Endothel eine gute Behandlungsmöglichkeit dar. Bei einer intraoperativen Perforation bleibt die Möglichkeit einer sog. Konversion zur Excimer-PKP mit allen Vorteilen der Excimerlaser-Trepanation.Indications The aim of excimer laser-assisted deep anterior lamellar keratoplasty (excimer-DALK) is, as in mechanical DALK, the treatment of keratectasia (keratoconus and pellucid marginal degeneration), stromal scars or stromal corneal dystrophy. A prerequisite for surgery is the absence of (pre‑) Descemet’s scars and an intact endothelium. Surgical technique After excimer laser-assisted trephination to 80% of the corneal thickness at the trephination site, intrastromal air injection (so-called big bubble) and lamellar corneal preparation, a lamellar anterior transplantation of the endothelium-free donor tissue is performed. The technique combines the advantages of DALK and excimer laser trephination. We describe the steps of an excimer-DALK from the Homburg Keratoconus Center (HKC). Conclusion Excimer-DALK is a viable treatment option for patients with intact endothelium. In cases of intraoperative perforation, conversion to excimer-perforating keratoplasty (PKP) with all the advantages of excimer laser trephination remains feasible

Altered Regulation of mRNA and miRNA Expression in Epithelial and Stromal Tissue of Keratoconus Corneas

Purpose: Evaluation of mRNA and microRNA (miRNA) expression in epithelium and stroma of patients with keratoconus. Methods: The epithelium and stroma of eight corneas of eight patients with keratoconus and eight corneas of eight non-keratoconus healthy controls were studied separately. RNA was extracted, and mRNA and miRNA analyses were performed using microarrays. Differentially expressed mRNAs and miRNAs in epithelial and stromal keratoconus samples compared to healthy controls were identified. Selected genes and miRNAs were further validated using RT-qPCR. Results: We discovered 170 epithelial and 1498 stromal deregulated protein-coding mRNAs in KC samples. In addition, in epithelial samples 180 miRNAs and in stromal samples 379 miRNAs were significantly deregulated more than twofold compared to controls. Pathway analysis revealed enrichment of metabolic and axon guidance pathways for epithelial cells and enrichment of metabolic, mitogen-activated protein kinase (MAPK), and focal adhesion pathways for stromal cells. Conclusions: This study demonstrates significant differences in the expression and regulation of mRNAs and miRNAs in the epithelium and stroma of Patients with KC. Also, in addition to the well-known target candidates, we were able to identify further genes and miRNAs that may be associated with keratoconus. Signaling pathways influencing metabolic changes and cell contacts are affected in epithelial and stromal cells of patients with keratoconus

A 27-year-old man with “corneal opacity” after being injured by a branch

(...

Associations of Independent IL2RA Gene Variants with Intermediate Uveitis.

The genetic background for the concomitance of uveitis and other autoimmune diseases remains elusive. Here the role of two IL2RA gene variants (rs11594656 and rs12722495) was investigated in intermediate uveitis and HLAB27 acute anterior uveitis.One hundred fifty-nine patients with HLAB27 acute anterior uveitis, 85 patients with intermediate uveitis, 138 HLAB27 negative controls and 100 HLAB27 positive controls were recruited for this case-control study. Main outcome measures were genotype distribution and allelic frequencies determined by polymerase chain reaction.The frequencies of carriers of the minor allele at rs11594656 and rs12722495 were significantly different in patients with intermediate uveitis compared to HLAB27 positive and negative controls combined (p<0.05). For rs12722495 the minor G allele was protective (genotypic OR: 0.29 [0.12-0.69]), and for rs11594656 the minor A allele conferred risk (genotypic OR: 1.59 [1.09-2.32]). No significant differences in genotype distribution were found between patients with HLAB27 acute anterior uveitis and HLAB27 positive or negative control subjects.We found rs11594656 and rs12722495 to be associated with intermediate uveitis but not with HLAB27 acute anterior uveitis. The genetic heterogeneity found at the IL2RA locus could help explain patterns of concomitance with other autoimmune diseases

Retropupillary Fixation of Iris-Claw Intraocular Lens for Aphakic Eyes in Children.

To report outcome, complications and safety of retropupillary fixated iris-claw intraocular lenses in a pediatric population.Retrospective study.Ten consecutive pediatric patients (15 eyes) underwent placement of retropupillary fixated iris-claw intraocular lenses between October 2007 and July 2013 at the Department of Ophthalmology, Medical University Graz and General Hospital Klagenfurt, Austria. Postoperative visual acuity and complications were analyzed.Median final best-corrected visual acuity improved by 0.12 logMAR from preoperative baseline. Mean postoperative spherical equivalent was -0.05 ± 1.76 D. No serious complications were observed intra- or postoperatively during the entire follow-up period of up to 40 months. One patient experienced a haptic disenclavation with IOL subluxation immediately after a car accident.Our study demonstrates that iris-claw intraocular lens implantation behind the iris is safe in children with lack of capsular support and yields excellent visual outcome with low complication rate

Early use of infliximab improves outcomes In patients with Rheumatoid Arthritis associated sight threatening ocular surface inflammation

Purpose: : Monoclonal antibody therapy such as Infliximab is currently advocated as a second line therapy in treating rheumatoid arthritis (RA) when there is failure to control disease with more than one disease modifying anti-α rheumatic drug (DMARD). However, whether it has a similar role in rheumatoid arthritis associated non-infectious ocular surface inflammatory is unclear. Current data on the use of anti-TNF-α therapy in this group of patients is limited. The purpose of this study is to evaluate the efficacy and safety of standard DMARD alone or in combination with Infliximab at inducing and maintaining disease remission in patients with sight threatening ocular surface disease. Methods: : Retrospective case series of 16 patients with RA was undertaken at a single unit. Equal numbers had either a step up in standard DMARD therapy or the addition of Infliximab to induce remission. Stabilization of melt, perforation, surgical intervention, time to remission and treatment related morbidity were the measured outcomes. Results: : Infliximab induced faster remission, within 4 weeks (1-8 weeks) than with standard DMARD alone, 9 months (4-20 weeks) (t-test, p&lt;0.002). Infliximab treated patients were more likely to be steroid independent. Two RA associated deaths occurred in standard DMARD therapy group. Conclusions: : The addition of Infliximab to standard DMARD therapy achieved rapid and full remission of inflammatory disease. Infliximab infusions were safe, well tolerated and maintained disease control in the longer term.This data supports the early and regular use of Infliximab in rheumatoid associated ocular inflammatory disease