Pterygium is a fibrovascular degenerative condition of the subconjunctival tissue that proliferates and grows into the cornea in the form of a vascularized fold, destroying the surface layers of the stroma and Bowmans membrane. This disease is common throughout the world. The etiology is not clear, but it is known that the appearance of pterygium is associated with exposure of the eye to ultraviolet rays. The treatment of the de novo occurring pterygium is a relatively simple task and involves surgical removal. But a simple excision is currently unacceptable due to the high recurrence rate. In order to minimize the risk of relapse, numerous adjuvant treatment methods are used, which include anti-metabolites such as Mitomycin C and 5-fluorouracil, amniotic membrane, various types of conjunctival and or limbal grafts; medications such as anti-vascular endothelial growth factor are sometimes used. In the clinical case presented in the article, we successfully used the technique of anterior lamellar keratoplasty and autoconjunctival transplantation in combination with intra-operative use of anti-metabolite Mitomycin C in a young patient with recurrent stage IV pterygium (degree of activity 3) twice unsuccessfully operated on. As a result of this surgical technique, the transparency of the cornea was restored and high visual acuity was obtained.
Saltzman’s nodular degeneration is a rare, non-inflammatory, slowly progressive degenerative disease of the cornea characterized by bluish-white nodules elevated above the surface of the cornea. More often nodules are located in the mid periphery of the cornea, they can spread into the optical zone. Sometimes localize along the limbus. They consist of dense heterogeneous collagen tissue with hyalinization, localized between the epithelium and Bowman’s layer. Can penetrate deeper into the stroma. The exact pathophysiological mechanism of the lesion is unclear. It is considered that this condition is associated with a violation of the structural relationship of epithelial cells against the background of chronic inflammation of the ocular surface, which leads to the destruction of the Bowman’s layer, the activation and migration of fibroblasts anteriorly, and the deposition of a disorganized extracellular matrix in subepithelial nodules. Clinically, the disease can be manifested by irritation and inflammation of the ocular surface, dryness or decreased vision, more often due to flattening of the cornea and astigmatism. In some cases, the formed tissue can be easily separated from the corneal surface, leaving Bowman’s layer almost intact. In this case, a subsequent phototherapeutic keratectomy may be required to “smooth” the surface. Relapses in these eyes are rare. In other situations (often with extensive peripheral vascularization), the lesions involve the anterior stroma, making it more difficult to remove them while maintaining the smoothness of the cornea. Several laser ablation procedures may be required, but there is a high risk of recurrence with this approach. It may be necessary to treat the meibomian gland’ dysfunction and dry eye syndrome that often accompanies Saltzman’s degeneration to reduce the risk of disease progression.
Relevance. Currently, all over the world, during cataract surgeries, a huge number of intraocular lenses (IOLs) made of different materials are implanted. Alongside with the development of modern IOL materials and designs, publications about their opacities appear. The nature and the localization of IOL opacities mainly depend on the properties of the material out of which the lens is made. Polymethyl methacrylate (PMMA) currently rarely used to manufacture IOLs, tends to cloud in the optical center due to structural breakdown, forming snowflake-like cracks. Opacities of acrylic IOLs depend on the degree of hydrophilic properties of the material. The deposition of crystalline deposits in the optical zone of hydrophilic acrylic lenses leads to a significant decrease in visual acuity and requires IOL explantation. There is a definite dependence of the occurrence of opacities in hydrophilic acryl on the patients concomitant diseases. In hydrophobic acrylic IOLs, vacuoles form, and glistenings occurs. Herewith, visual functions, as a rule, do not suffer. Purpose: to find out what structural changes in the IOL led to the need to remove them from pseudophakic eyes due to a decrease in visual acuity. Materials and methods. Four clouded IOLs made from different materials were examined. The lenses were studied using a SUPRA 55VP scanning electron microscope (Carl Zeiss, Germany) using a secondary electron detector. Element distribution maps on the surface and inside the lenses were collected using an X-max 80 mm2 energy dispersive X-ray analysis detector (Oxford Instruments, UK). Results. A hydrophilic lens with hydrophobic coating became cloudy 5 years after implantation. Hydroxyapatite crystals were found on all parts of the IOL along its surface. In a hydrophobic acrylic IOL, microvacuoles and cavities in the optical center were found using scanning electron microscopy. Two PMMA IOLs underwent self-destruction within 8 years after implantation. Chemical analysis of PMMA lenses did not reveal any inorganic compounds. Conclusion. One of the complications of IOL implantation is an impairment of their transparency. Factors associated with IOL material and manufacturing, as well as the patients comorbidities, can lead to lens opacification at various terms after surgery.
Neurotrophic keratopathy (NTK) is an orphan, polyetiological disease that has recently been identified more frequently. Drug-resistant stages of NTC often require urgent surgical treatment. Subsequently, such patients need to be done keratoplasty, the consequences may be unsatisfactory in the presence of a significant impairment of innervation.Purpose: to evaluate the effectiveness of lamellar anterior keratoplasty in patients with the outcome of stage II and III NTK.Material and methods. The study included 22 patients (22 eyes) aged 21 to 88 years. All patients were divided into two main groups. The first group consisted of 12 patients with NTC as a result of damage to the main stem of n.trigeminus and its branch n.ophthalmicus, the second group consisted of 10 patients — NTC as a result of toxic damage due to uncontrolled instillation of local anesthetics and eyedrops with preservatives. Before inclusion in the study, 14 patients underwent autoconjunctivoplasty for the treatment of drug-resistant NTK stage II and III, 8 — corneoscleral flap coating. All patients underwent lamellar anterior keratoplasty. The following parameters were assessed: maximally corrected visual acuity (MCVA) and coefficient of corneal sensitivity reduction in an approximate way before and after 1 day, 2 weeks, 1 and 3 months after surgery; tear film break- up time (Norn test) and Schirmer’s I.Results. In the second group an increase in the level of BCVA and a clear graft was observed in all patients, while in the first group, the level of BCVA worsened, and the graft was with reduced transparency. Significant difference between the examined and the fellow eye in the compared groups according to the tear film break-up time test was not detected. In the first group statistically significant decrease of tear production according to the results of the Schirmer’s test was identified. A weak correlation was found between corneal sensitivity and BCVA after surgery in group II.Conclusion. We have demonstrated the high efficiency of automated layered anterior keratoplasty in the outcomes of advanced stages of NTK of toxic etiology. In patients with NTC outcome as a result of stem injury, surgical treatment led to a satisfactory cosmetic result, but visual acuity did not change significantly.
Background. Scleral lenses, due to their benefits, hold a specific position among all types of contact lenses. Some years ago, they began to be used successfully not only for the correction of complex types of refractive errors, when other types of correction failed to achieve satisfactory visual function and visual rehabilitation of patients, but also as a therapeutic system in the management of ocular surface disease. Purpose. To evaluate the efficacy of rigid gas permeable miniscleral contact lenses as a therapeutic system in the management of patients with dry eye syndrome by filling the space under the lens with a non-preserved sodium hyaluronate solution. Materials and methods. In the study, 7 patients (11 eyes) with keratectasias after corneal surgery and concomitant dry eye syndrome were included. In the treatment and rehabilitation of these patients, miniscleral contact lenses were used during daytime with additional filling of the space under the lens with a non-preserved sodium hyaluronate solution. Results. As a criterion of the effectiveness of miniscleral contact lens use for therapeutic purposes, along with a significant increase in visual function in patients with complex corneal pathology, the elimination of discomfort due to restoration of the corneal epithelium integrity and improvement of their quality of life is considered.
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