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PubMed1997

Fluorescence in-situ hybridization (FISH) reveals that in chronic myelogenous leukaemia (CML) following interferon-alpha therapy, normalization of megakaryocyte size is associated with the loss of bcr/abl translocation.

AIMS: In addition to predominant granulocytic proliferation, bone marrow morphology in Philadelphia chromosome positive (Ph1+) CML is characterized by atypical dwarf or microforms of megakaryocytes. However, following therapy with interferon-alpha 2b (IFN), these micromegakaryocytes occur less frequently. The purpose of this study was to elucidate whether the reappearance of normal megakaryocytes may be associated also with a reduction of the bcr/abl-positive cell clone. METHODS AND RESULTS: Fluorescence in-situ hybridization (FISH) technique in combination with immunomorphometry (CD61) was performed on trephine biopsies. A total of 311 CD61-positive megakaryocytes, including precursors and atypical microforms, were evaluated in pre-treatment specimens derived from 11 patients with Ph1+ CML. A specific fusion site marking the bcr/abl translocation was found in 87% of megakaryocytes which showed a size of 169 +/- 35 microns2. In untreated patients, atypical microforms (size 200 microns2) were observed in 66% of the total megakaryocytic population. Following IFN therapy 369 megakaryocytes could be analysed in sequential examinations and were found to display a significant decrease (63%) in positive fusion signals. In addition there was also a significant enhancement in average size (252 +/- 66 microns2) reflecting a reduction in the number of micromegakaryocytes (43%). These findings were particularly conspicuous in three patients with a major to complete cytogenetic remission. CONCLUSIONS: A normalization of megakaryocyte size following IFN therapy in CML is significantly associated with a loss of the bcr/abl translocation site and therefore indicates a (partial) recovery of normal haematopoiesis.

Fusion Proteins, bcr-abl↗
PubMed1997

Immunohistochemical analysis of decalcified paraffin-embedded human bone marrow biopsies with emphasis on MHC class I and CD34 expression.

AIMS: To identify the stromal structures and haematopoietic cell lineages in normal bone marrow. The optimal conditions were studied for the reactivity of a panel of antibodies, applicable to paraffin sections of decalcified trephine biopsies using antigen retrieval methods. METHODS AND RESULTS: Two methods of antigen retrieval (pepsin and acid citrate buffer) were tested. For the demonstration of most antigens and for reduction of background staining, heating in acid citrate buffer was preferred. In the case of elastase and von Willebrand Factor (factor VIIIrAg) pepsin pre-treatment was optimal, whereas Ulex europaeus agglutinin (UEA-1) and alpha-smooth muscle actin (alpha-SMA) required no pretreatment. Staining patterns obtained after 48 h EDTA decalcification and short electrolytic decalcification were identical. Both methods allowed recognition of HLA-A and HLA-B antigens, isolated CD34+ cells, mono-histiocytic cells (CD68+), myeloid cells (elastase and myeloperoxidase), erythroid cells (glycophorin C) and of megakaryocytic cells (Factor VIIIrAg). A relative simple lymphocyte-subset analysis was possible in decalcified paraffin sections allowing recognition of B-cells (CD20+) and T-cells (CD3+ and CD45RO+) in frequencies comparable to frozen sections. Suitable stromal cell staining was achieved by vimentin and desmin antibodies, whereas the bone marrow capillary network was visualized by CD34, factor VIIIrAg and UEA-1. CONCLUSIONS: This immunohistochemical study indicates that all cellular components of the haematopoietic microenvironment of the bone marrow can be identified in decalcified paraffin sections using antigen retrieval methods and that the time of decalcification can be reduced to 1-1.5 h.

Antigens, CD34↗
PubMed1997

Incidence of apoptosis in HIV-myelopathy, myelodysplastic syndromes and non-specific inflammatory lesions of the bone marrow.

Myelodysplastic syndromes, AIDS-related myelopathy and non-specific inflammatory reactions (mostly rheumatoid myelitis) are characterized by normo- to hypercellular bone marrow, but frequently display cytopenias in the peripheral blood. In the current study we have addressed the question whether this situation reflects an increased programmed cell death in haemopoiesis. For this purpose, the in situ end-labelling technique was applied to formalin-fixed and paraffin-embedded trephine biopsies derived from patients and a control group without any haematological disorder. Results were evaluated by morphometry. Significantly more apoptotic cell death was observed in the haemopoietic marrow of patients with either disease. Using double-immunohistochemistry with the monoclonal antibody PG-MI (CD68), we were able to demonstrate that approximately one third of the apoptotic cells were ingested by macrophages. Our findings are in keeping with previously published data that postulated increased frequencies of macrophages in these disorders as well as raised serum levels of TNF-alpha.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Changing patterns of histological subgroups during therapy of Ph1+ chronic myelogenous leukaemia.

AIMS: Bone marrow histopathology reveals a striking heterogeneity at diagnosis of Philadelphia chromosome positive (Ph1+) chronic myelogenous leukaemia (CML). Based on semiquantitative evaluations of the number of megakaryocytes and the content of fibres, various histological subtypes have been postulated. However, little information exists on whether these groups represent stable categories of the different classification systems and whether therapeutic regimes exert any influence on the putative shift of histological patterns. METHODS AND RESULTS: A retrospective clinicopathological study was performed on 396 bone marrow biopsies derived from 173 patients. There were at least two representative trephines taken at diagnosis and at median intervals of 16 months. Processing of the specimens involved immunostaining with CD61 (megakaryopoiesis) and Ret40f (erythropoiesis) and Gomori's silver impregnation technique. Based on morphometric analysis and in accordance with the general appearance of bone marrow histology three different histological subtypes were distinguished. These consisted of a granulocytic (51 patients), a predominantly megakaryocytic (73 patients) and a myelofibrotic pattern (49 patients). Follow-up biopsies revealed that a significant transition of histological groups occurred and that, independently of treatment modalities, the myelofibrotic category was associated with an unfavourable prognosis. Of the 124 patients without myelofibrosis at onset, 42% later transformed into the myelofibrotic subtype. However, these patients showed no prevalence of either a pre-existing granulocytic or megakaryocytic growth. Myelofibrotic changes were significantly associated with interferon (IFN) and busulfan (BU) therapy. On the other hand, a transition of a myelofibrotic into a nonfibrotic subtype was detectable in 17 of the 49 patients under study and related to hydroxyurea (HU) treatment. CONCLUSIONS: Histological classification systems of bone marrow features in CML do not represent stable patterns, but may be significantly altered by therapy, in particular IFN and HU.

Adult↗
PubMed1999

Schnitzler's syndrome: report of a case with progression to Waldenström's macroglobulinaemia.

Schnitzler's syndrome is a rare but distinct entity in which chronic urticaria is a prominent feature. Our patient presented with an urticarial rash associated with intermittent fevers, lethargy, a migratory polyarthralgia and loss of weight. Skin biopsy revealed a neutrophilic urticaria. An IgM kappa paraprotein was detected on serum protein electrophoresis at a level of 8 g/L (0.6-2.5 g/L). Bone marrow biopsy was normal. Marked improvement of the arthralgia, fever and lethargy was obtained with oral prednisolone. The urticarial rash, however, was only partly responsive. For the next 10 years the patient remained stable but corticosteroid dependent. Over a period of 10 years the IgM paraprotein had slowly risen to 47 g/L. Repeat bone aspirate and trephine revealed a diagnosis of a low grade lymphoplasmacytic lymphoma consistent with Waldenström's macroglobulinaemia. To date, despite six cycles of chemotherapy with oral chlorambucil, his disease remains persistent but stable.

Female↗
PubMed1999

Ipsilateral rotational autokeratoplasty for the management of corneal opacities.

PURPOSE/BACKGROUND: Penetrating keratoplasty is the logical solution for the management of corneal opacities. In situations such as in Papua New Guinea, where donor corneal tissue is scarce and corneal opacities are plenty, an alternative procedure for the management of corneal opacities in the form of ipsilateral rotational autokeratoplasty was considered. METHODS: In the present prospective study, ipsilateral rotational autokeratoplasty was performed in 17 eyes over a 2 year period in a general hospital. The patient's cornea was trephined eccentrically and the corneal opacity was dialed out of the visual axis and was replaced by clear peripheral cornea. RESULTS: Most opacities were leucomata (76.4%). The average size of the opacity was 5.1 mm and the corneal button size was 7 mm.A final visual acuity of 6/18 or better was obtained in 64.7% of cases (at 12 months). No significant postoperative complications were encountered. No complex formula was needed to calculate the size of the button and, by simply adding 3 mm to the pupillary diameter in standard illumination, one could make an estimation of the graft diameter. CONCLUSIONS: Rotational autokeratoplasty has a definite role in places where donor corneal tissue is scarce, in patients in whom long-term steroids are a risk or in situations where follow up of patients is difficult. Rejection is a theoretical impossibility, but late endothelial failure could occur, requiring regrafting. Rotational autokeratoplasty should be seriously considered as an alternative to conventional penetrating keratoplasty.

Adolescent↗
PubMed1999

Late presentation of a unilateral sporadic retinoblastoma in a 16-year-old girl.

BACKGROUND: Retinoblastoma is the commonest intraocular tumour of childhood with the majority of cases being diagnosed before 5 years of age. Late presentation of retinoblastoma is rare. CASE HISTORY: A healthy 16-year-old Caucasian girl presented with a 1-day history of blurred vision in the left eye. Examination revealed an inferonasal mass in the left retina with an overlying haemorrhage and vitreous seeding. Imaging studies revealed a 5-mm densely calcified opacity. Other investigations, including cerebral spinal fluid examination, bone marrow aspirate trephine, toxocara serology and serum protein studies, were normal. After considering the differential diagnoses such as toxocariasis and Coat's disease, a diagnosis of late-presenting retinoblastoma was made. The patient subsequently underwent enucleation with a primary orbital implant. The diagnosis was confirmed histopathologically. CONCLUSION: Late presentation of retinoblastoma is uncommon but can be a cause of acute visual impairment in the non-paediatric age group. Retinoblastoma should be considered in the differential diagnosis of a fundal mass in any age group.

Adolescent↗
PubMed1999

Immunohistochemical assessment of human bone marrow macrophages in hematologic disorders.

Changes in bone marrow macrophages may be associated with abnormal hematopoiesis in various hematologic disorders. We immunohistochemically evaluated the density of macrophages in bone marrow trephine biopsies. In reactive erythroid hyperplasia (hemolytic anemia and megaloblastic anemia), the macrophages slightly increased in density, extending their cytoplasmic processes between hematopoietic cells. In erythroid hypoplasia (pure red cell aplasia), they became rounded and frequently had hemosiderin granules. There was no significant difference in the macrophage density in the hematopoietic area between erythroid hyperplasia and hypoplasia. The macrophages increased in density in myeloproliferative disorders (polycythemia vera, chronic myelogenous leukemia and primary thrombocythemia). In myelofibrosis, some macrophages became extremely elongated along the line of the fibroblastic cells. In contrast, in conditions in which myelopoietic activity is considerably impaired (aplastic anemia, acute leukemia and multiple myeloma), they significantly decreased in density. These results suggest that the morphologic change in bone marrow macrophages is associated with erythropoietic activity and that there is a correlation between macrophage density and myelopoietic activity.

Antibodies, Monoclonal↗
PubMedDate not supplied

Altered collagen metabolism and delayed healing in a novel model of ischemic wounds.

Cellular mechanisms occurring in the healing wound have been well described in various animal models. However, the events associated with wound healing seen in ischemic skin have not been as thoroughly defined. In this series of experiments, we created a novel model of excisional skin wounds under gradient ischemia to study the cellular and extracellular events leading to delayed healing. We hypothesized that altered collagen metabolism accounts for delayed wound healing in ischemic skin. Three pairs of 4 mm punch wounds were made 4 days after bipedicle skin flaps were created on the dorsum of rats. Sham-operated control animals had the same punch wounds without flap creation. The kinetics of excisional wound healing were measured by means of computerized planimetry. In addition, wounds were excised with a 6 mm trephine, radiolabelled with ((3)H)-proline and in vitro collagen synthesis determined as collagenase digestible protein along with quantitation of DNA content. Total collagen deposition was determined as 4-hydroxy-L-proline by high-performance liquid chromatography, and wounds were histologically evaluated. Data was analyzed by means of two-way analysis of variance. Although control wounds healed by day 10, flap wounds consistently had greater surface area on days 2, 4, 6, 8, and 12 (p < 0.001). Relative collagen synthesis (% collagen/noncollagen protein), as measured by an in vitro synthesis method, showed no statistically significant differences between flap and controls wounds. However, the total collagen content (deposition) as measured by 4-hydroxy-l-proline was significantly lower in flap wounds compared with controls on days 7 (p < 0.05) and 9 (p < 0.001). In addition, a significant increase occurred in DNA content in the flap wounds on days 7 (p < 0.05) and 9 (p < 0.001) versus control wounds. These data indicate that, in ischemic wounds, significantly less collagen is deposited despite the inherent ability of the tissue to synthesize appropriate levels of collagen. Because the in vitro collagen synthesis technique only assesses the ability of the tissue to synthesize collagen in a well oxygenated environment, one cannot be assured that the tissue expresses this potential in vivo. However, these data are consistent with the hypothesis that the delay in wound closure is due to an alteration in collagen metabolism which results in a net decrease in collagen accumulation. Because of the observed increase in DNA within the ischemic wounds, we suggest that there is prolonged inflammation in these wounds which may enhance collagen degradation through the release of proteases. In addition, there may be an inability of the tissue to maintain appropriate levels of collagen in this inflammatory wound environment.

Journal Article↗
PubMedDate not supplied

Wound epithelialization deficits in the transforming growth factor-alpha knockout mouse.

In vitro, transforming growth factor-alpha is an important factor controlling epithelial cell proliferation and migration. However, the transforming growth factor-alpha knockout mouse has shown no wound epithelialization defect in tail amputation and full-thickness back wounds. To resolve this disparity, we combined a full-thickness head wound and a partial-thickness ear wound on the transforming growth factor-alpha knockout mouse for analysis of wound epithelialization with or without granulation tissue formation. Three-millimeter ear wounds were made on the transforming growth factor-alpha knockout and heterozygous control mice. Full-thickness head wounds were made using a 6-mm trephine on the crown of the skull. In the ear model, transforming growth factor-alpha knockout mice had significantly larger epithelial gaps versus control at post-operative day 3 and 5. Epithelial thickness at the wound edge of transforming growth factor-alpha deficient mice was also depressed at post-operative day 3 and post-operative day 5 compared to control mice. On post-operative day 8, most wounds of both groups were epithelialized. In contrast, no difference in epithelial gap or new granulation tissue was found in the head model. The data support the concept that transforming growth factor-alpha plays a significant early role in wound epithelialization in vivo but its deficit is compensated if accompanied by granulation tissue formation. The data further show the importance of appropriate wound models to address the role of vulnerary factors.

Animals↗
PubMed1999

Micro-organisms responsible for osteo-articular infections.

Identification of the aetiological agents responsible for bone and joint infections requires either hard to obtain specimens that are easy to interpret, or easy to obtain specimens of difficult interpretation. Isolates obtained by blood cultures, arthrocentesis, or trephine or surgical biopsy bone samples are usually clinically significant. In contrast, samples obtained from sinus tracts or through open wounds are very often easy to obtain but difficult to interpret. Micro-organisms such as Staphylococcus epidermidis are the most common cause of infections around prosthetic joint materials but are usually of little significance when obtained from the sinus tract of a patient with chronic osteomyelitis of the tibia without osteosynthesis. Other micro-organisms to be interpreted with caution include Corynebacterium spp. and Enterococcus spp. The most important families of antimicrobial agents and their utility in bone and joint infections are briefly reviewed at the end of the chapter. Bone and joint infections require long-term antimicrobial therapy based on the correct diagnosis and the appropriate selection of antimicrobial treatment.

Arthritis, Infectious↗
PubMed2003

Clinicopathological definition of Waldenstrom's macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom's Macroglobulinemia.

This presentation represents consensus recommendations for the clinicopathological definition of Waldenstrom's macroglobulinemia (WM), which were prepared in conjunction with the Second International Workshop held in Athens, Greece during September 2002. WM is an uncommon lymphoproliferative disorder characterized primarily by bone marrow infiltration and IgM monoclonal gammopathy. It should be considered a distinct clinicopathological entity rather than a clinical syndrome secondary to IgM secretion. The underlying pathological diagnosis in WM is lymphoplasmacytic lymphoma as defined by the World Health Organization (WHO) and Revised European-American Lymphoma (REAL) classification criteria. The concentration of monoclonal IgM can vary widely in WM and it is not possible to define a concentration that reliably distinguishes WM from monoclonal gammopathy of undetermined significance (MGUS) and other lymphoproliferative disorders. A diagnosis of WM can therefore be made irrespective of IgM concentration if there is evidence on a bone marrow trephine biopsy of bone marrow infiltration by lymphoplasmacytic lymphoma with predominantly an intertrabecular pattern, supported by appropriate immunophenotypic studies. Simple criteria to distinguish patients with symptomatic WM who require therapy from those with asymptomatic WM and MGUS were also proposed. Patients with clinical features attributable to IgM monoclonal gammopathy but no overt evidence of lymphoma are considered to constitute a distinct clinical group and the term "IgM-related disorders" is proposed.

CD5 Antigens↗
PubMed2001

Influence of routine bone grafting on the stability of the non-cleft Le Fort 1 osteotomy.

Although bone grafting is known to improve stability after midface cleft osteotomy, it is advocated only rarely for people without clefts. To assess the influence of routine bone grafting on stability in such patients we analysed radiographic data of 112 patients retrospectively. All patients had had Le Fort 1 osteotomy with autogenous bone grafts harvested by trephine from the iliac crest, and 76 had had concurrent mandibular procedures. Rigid internal fixation was adopted throughout. Impaction proved to be the most stable move. While there was little postoperative relapse of the anterior maxilla (0.9%), the posterior maxilla tended to move further upwards with time (2.3%). Overall relapse after advancement and inferior repositioning was low (3.5% and 5%, respectively). The only complication noted at the iliac crest donor site was spread of the scar, which affected three patients. When we compared these results with previously published data, they suggested that in patients without clefts rigid internal fixation combined with bone grafting may improve stability after selected Le Fort 1 osteotomy moves.

Adolescent↗
PubMed2000

[Corneal dimensions in various types of corneal dystrophies and their effect on penetrating keratoplasty].

PURPOSE: To achieve a high optical performance and a low rate of immunologic graft reactions after penetrating keratoplasty (PK) an optimal graft outline has to be chosen. The purpose of this study was to compare the corneal dimensions of patients with various types of corneal dystrophies to normal control eyes. METHODS: In patients with keratoconus (n = 117), Fuchs' (n = 100), granular (n = 28), lattice (n = 26) and macular corneal dystrophy (n = 25) and normal controls subjects (n = 93) standardized slit lamp photographs of the cornea were taken. Using a computerized planimeter (SummaSketch III, Summagraphics Corp., Seymour, USA) 13 x 18-cm color prints (total magnification x12) were assessed morphometrically. RESULTS: On average, the maximal and the minimal diameter of corneas in patients with macular dystrophy (12.3 mm/10.6 mm) and normal controls (12.1 mm/10.5 mm) were significantly smaller (p < 0.02) than in patients with keratoconus (12.6 mm/10.9 mm), granular (12.7 mm/10.8 mm) and lattice dystrophy (12.8 mm/10.8 mm), but significantly larger (p < 0.02) than in patients with Fuchs' dystrophy (11.9 mm/10.4 mm). In Fuchs' dystrophy the corneas were significantly (p < 0.0001) more elliptical than in all other dystrophies and controls. The rotation of the maximal diameter from the horizontal ranged from 36 degrees nasal inferior to 44 degrees nasal superior and did not differ between dystrophies and controls. CONCLUSIONS: In patients with keratoconus, lattice and granular dystrophy larger grafts may be considered to improve the optical performance without promoting the risk of immunologic graft reactions after PK. As a rule, we use 8.0/8.1 mm (recipient/donor) for keratoconus and 7.5/7.6 mm for Fuchs' dystrophy. However, the graft diameter has to be determined individually in each single eye immediately before trephination.

Adult↗
PubMed2000

[Interim results from the prospective "Erlanger Non-high-risk Penetrating Keratoplasty Study" in 207 patients].

BACKGROUND: Immunologic graft rejection targeted against corneal endothelium is the most frequent cause for graft failure after corneal transplantation. The purpose of this prospective study was to assess the frequency, early symptoms, prophylaxis and therapy monitoring of corneal graft rejection following non-high-risk penetrating keratoplasty (PK). PATIENTS AND METHODS: From February 1997 to May 1999, 237 patients undergoing non-high-risk PK have been enrolled in this prospective study. We evaluated 207 patients (103 female, 113 right eyes, recipient age 54 +/- 20 years, donor age 59 +/- 17 years). In 2 randomized treatment studies we compared the efficacy of postoperative short-term (ST = 6 months) versus long-term (LT = 12 months) topical steroid therapy on the incidence of graft rejection and the effect of high- versus low-dose systemic steroid therapy on the prognosis after a graft rejection. Follow-up examinations included, laser-tyndallometry, corneal topography analysis, endothelial cell count and pachymetry. RESULTS: The main indications for PK were keratoconus (n = 93), endothelial dystrophy Fuchs (n = 52) and bullous keratopathy (n = 35). In 151 (73%) patients, non mechanical trephination with the 193 nm Excimer laser was performed. Up to now, 78 patients were randomized into two groups comparing the postoperative therapy with topical steroids. During follow-up (median: ST: 13.5 months; LT: 12.5 months, maximum 25.3 months) episodes of endothelial graft rejection (3 chronic focal, 8 acute diffuse) showed 11 eyes of 11 patients. Five patients each had short-term and long-term topical steroid treatment. In 1 patient the graft rejection occurred before randomization at 6 months. Six patients with graft rejection episodes underwent a PK only (54% of graft rejections, 4.4% of all patients). In the remaining 5 patients, PK was combined with a lens surgery (46% of graft rejections, 6.9% of all patients). Ten of 11 corneal grafts regained their full function under treatment with systemic and local steroids. CONCLUSION: The frequency of episodes of graft rejection in our study was lower than usually reported in the literature. A good compliance of patients appears to be a major factor for improved prognosis of the graft after PK and in case of graft rejection. Until now no significant differences between short-term or long-term postoperative topical steroid therapy could be detected regarding the incidence of corneal graft rejection.

Administration, Oral↗
PubMed2001

[Wavelet representation of corneal topography data after nonmechanical penetrating keratoplasty--a clinical study].

BACKGROUND: Corneal surface irregularities may limit the visual outcome after penetrating keratoplasty (PK). Corneal topographers mainly render empirically derived and system-specific statistical indices for characterization of superficial inhomogeneities which may lack clinical evidence and make inter-system comparisons difficult. The purpose of this study was to detect and quantify focal surface irregularities of the cornea after nonmechanical PK by 2-dimensional wavelet decomposition based on corneal topography data. PATIENTS AND METHODS: Our study included 15 patients with keratoconus and 10 patients with Fuchs' dystrophy with all-sutures-out after penetrating keratoplasty. For trephination we used the excimer laser MEL60 (Aesculap-Meditec, Germany) (7.5/7.6 mm diameter in dystrophies, 8.0/8.1 mm in keratoconus, double-running 10-0 nylon suture). After suture removal a complete ophthalmological examination including OrbScan topography analysis (Orbtec, USA) was performed. The refraction data were extracted via "data recorder" and decomposed using 2-dimensional wavelet analysis methods (Daubechies-4-wavelets on five scales of resolution). Corneal irregularities were quantified (scale 1 = fine details to scale 5 = coarse details). RESULTS: All detail coefficients (horizontal, vertical and diagonal) correlated statistically significant with the "Irregular Astigmatism" provided by the OrbScan-system (p < 0.05). In scale 3 and 4 a relative maximum of the wavelet detail coefficients occurred, whereas the coefficients at scale 2 and 5 were significantly smaller. The horizontal and vertical detail coefficients correlated significantly inversely with the best-corrected visual acuity (p < 0.04). All detail coefficients were significantly lower in the patient group with keratoconus compared to Fuchs' dystrophy. CONCLUSIONS: Wavelet decomposition of corneal topography refraction data allows an analytical isolation and quantification of focal corneal superficial irregularities. This algorithm is independent of the currently used topography system and allows a smoothing of the raw data set adapted to scale of resolution and data compression.

Adult↗
PubMed2001

Lacrimal drainage system endoscopic examination and surgery through the lacrimal punctum.

BACKGROUND: To describe an approach to restore the physiological tear passages of an obstructed lacrimal drainage system with instruments introduced through one of the lacrimal punctum. METHOD: In a first step a miniature endoscope (Ø: 0.9, 1.1, 1.3 mm) is introduced in one of the lacrimal punctum to visualize the level, the extent, and the nature of an obstruction along the lacrimal drainage system. In a second step, the miniature endoscope is replaced by a lacrimal trephine (Ø: 0.9, 1.1, 1.3 mm) that holds an optic fiber in its lumen, and the obstruction is removed under endoscopic visual control. The entire procedure is performed under local anesthesia. RESULTS: With this approach it is possible to visualize and remove partial or total fibrous obstructions along the lacrimal drainage system (lacrimal canaliculus, nasolacrimal duct). Lacrimal sac lithiasis can also be fragmented and eliminate in the nose through the nasolacrimal duct. During or after the procedure only minor, and no major, complications can sometime occur, such as hematoma or edema (after lacrimal irrigation) of the surrounding soft tissues. CONCLUSION: The approach described here is straight forward, quick, and can be performed under visual endoscopic control and in local anesthesia. With this approach partial stenosis can easily be diagnosed and cured. This procedure might potentially change our current concepts regarding surgical indications for obstructive epiphora and dacryocystitis. However, the long-term results of this type of surgery need to be challenged.

Dacryocystorhinostomy↗
PubMedDate not supplied

[Visual acuity and astigmatism after eccentric penetrating keratoplasty - a retrospective study on 117 patients].

PURPOSE: The purpose of this study was to asses the functional results of eccentric homologous penetrating keratoplasty in respect of diagnosis as well as position and size of the corneal graft. PATIENTS AND METHODS: In this retrospective study, visual acuity and astigmatism of 117 cases of a round eccentric homologous penetrating keratoplasty in 91 eyes of 91 patients were analysed. The PK became necessary because of a corneal ulcer (104), 6 eyes with corneal scars and 7 eyes with ectatic corneal diseases. Using 84 postoperative slides the following parameters were quantified: graft diameter and transparency, distance of the geometric centre of the cornea from the central trephination margin (distance) as well as from the geometric centre of the graft (decentration). Seventeen grafts were classified as eccentric peripheral keratoplasty (mean diameter 5.0 +/- 1.7 mm) with the optical axis through the host cornea and 67 as eccentric central keratoplasty (7.0 +/- 1.3 mm) with the optical axis through the graft. RESULTS: The average follow-up period was 25 months. The astigmatism after 3/12/24 months was 6.7/6.3/5.5 D, but was irregular and not measurable in 74 %/52 %/49 %. The astigmatism increased with increasing decentration (24 months, p = 0.04). After 3/12/24 months, the VA in ulcers was 0.1/0.16/0.16, in scars 0.2/0.6/0.5 and in ectatic diseases 0.3/0.5/0.6. The position of graft and the visual acuity did not correlate significantly. After 24 months, larger the graft size was associated with better visual acuity. With increasing decentration the visual acuity decreased (p = 0.02) and was significantly lower (0.15) in the case of - 2.0 < distance < 2.0 mm than in the case of distance > 2.0 mm (0.4; p = 0.01). CONCLUSION: The diagnosis resulting in eccentric penetrating keratoplasty seems to have a major impact on the long-term functional prognosis of visual acuity. In addition, visual acuity is limited by high and often irregular astigmatism. Our results indicate that an increasing decentration of the graft is not invariably associated with decreasing visual acuity, provided the graft-host junction is not located in direct proximity of the optical axis.

Adolescent↗