[Perforating keratoplasty and cataract extraction--a two-stage or single-stage operation?].
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Biomedical subjects
Publications and source records attributed to D von Domarus.
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In 75% of the patients with malignant melanoma of the choroid useful vision can be retained by beta-radiation with ruthenium-106/rhodium. Tumors with a prominence of more than 6 mm should be treated only for very special reasons. There is a statistically proven correlation between the initial tumor volume and the occurrence of residual tissue volume. Histopathological investigations have shown that residuals of the tumor do not permit any conclusions concerning the dignity or vitality of tumor cells. The risk to life is not increased by the conservative procedure, and it may even be reduced.
This is a clinical, histopathological and electron microscopical study on the spheroidal degeneration of the cornea by means of 48 histologically verified cases. False clinical diagnoses are surveyed and the presumed mechanism of the development of spheroidal degeneration is discussed.
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Human and porcine corneas were cultured in organ-culture medium at 32 degrees C for long-term preservation and study of endothelial cell death. The endothelium was examined and re-examined at different intervals by using a phase contrast microscope and dual vital staining with alizarin-red S and trypan-blue. The appearance of degenerative vacuoles (which we called "death vacuoles" or "water-bubble bodies") as the first visible structural change in the process of cell death was very characteristic. While these vacuoles increased in size and number, the nucleus and cell-border disintegration was proceeding to the stage at which the cell was lost, leaving behind vacuoles on the Descemet's membrane, which we called the "endothelial graveyard."
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The mean endothelial cell count of 282 donated corneas was 2,665 cells/mm2, and the mean donor age was 56.01 years. The majority of the donors were over the age of 40 years, and the major causes of death were malignancies and myocardial infarction. Vital staining of the endothelium and direct evaluation of cells with an inverted phase contrast microscope were used in assessing the viability of this monocell layer. Evaluation of endothelial photomicrographs revealed that the cell count falls in the first three decades of life and eventually stabilizes around 2,600 cells/mm2. It is therefore suggested that patient age should not be the primary criterion for donor corneal selection.
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The toxicity of different procedures utilized for the sterilization of intraocular implant material was assessed on the endothelium of organ-cultured porcine corneas. Polymethylmethacrylate lenses sterilized by treatment with sodium hydroxide (NaOH), ethylene oxide, formaldehyde, and gamma radiation were added to a culture medium containing normal porcine corneas. Considering the viability of endothelial cells, appearance of intracellular degenerative vacuoles, and denudation of corneal Descemet's membrane as criterion for the evaluation of toxicity of different methods of sterilization, the NaOH-treated lenses were found to be the least toxic to porcine corneal endothelium. Phase-contrast microscopy and vital staining of the endothelium permitted direct viewing of the endothelium aiding in the assessment of toxicity.
We studied five intraocular lens implants removed for various reasons by light, transmission, and scanning electron microscopy. Four implants were Binkhorst four-loop lenses; the fifth was of an unidentified type. The durations of implantation ranged from three to 36 months, with an average of 14 months. The surface of all implants was covered with a thin acellular membrane of unknown nature. On top of this membrane we found different types of cells that are normally involved in a foreign-body reaction. These included fibroblasts, histiocytes, epithelioid cells, and multinucleated foreign-body giant cells, in all stages. Our findings suggested that iris-fixed artificial lenses are subject to a defensive cellular reaction by the host. The limited extent of this reaction was correlated with the success of the implant.
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In ophthalmology not too much attention is given to infectious disease due to hepatitis B virus. On enucleated donors' eyes with known hepatitis B viraemia we determined the distribution of HBsAG (hepatitis B surface antigen). Virus-associated antigen could not only be demonstrated in vascularized structures, but also in corneal epithelium and anterior chamber fluid.
Intra- and postoperative complications of iris-fixated 4-loops Binkhorst intraocular lens implants were studied. The horizontally placed lens implants, iris-fixated with two prolene sutures, were found to be the best placed, considering complications like lens subluxation or dislocation. Iris angiography, done 9 days to 18 months after lens implantation, revealed no local iris damage at the suture sites.
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