PURPOSE: To evaluate the safety and efficacy of using corneal stromal lenticules (CSLs) obtained during refractive surgery Refractive Lenticule Extraction (ReLEx) with the Small Incision Lenticule Extraction (SMILE) procedure for the treatment of corneal ulcers. METHODS: This retrospective study included 12 eyes of 12 patients, 7 men and 5 women with varying degrees of corneal ulcer. The mean age was 64 ± 18 (range 34 to 95 years). The monitoring included corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, a Seidel test, stability of the graft and anterior segment optical coherence tomography (AS-OCT) inspection. Patients were closely monitored for possible postoperative complications for at least 6 months. RESULTS: In 7/12 (58%) eyes, the corneal ulcer was successfully sealed with CSL and amniotic membrane (AM) without the need for any additional surgical intervention. In 3 eyes, penetrating keratoplasty (PK) was needed in addition to CSL transplantation and in 2 eyes the scleral patch was used to fully seal after CSL transplantation. During the follow-up period no signs of rejection or infection were detected in any patient. CONCLUSION: The use of CSLs from ReLEx SMILE may be considered as an alternative method for the treatment of corneal ulcers before a more extensive and definitive solution - PK - is used. Our preliminary findings suggest that properly performed CSL transplantation using cryopreserved lenticules is a safe and effective method to temporarily cover the corneal partial-thickness defect or even perforation.

• Klíčová slova
• CSL transplantation, ReLEx SMILE, amniotic membrane, corneal stromal lenticule, corneal ulcer,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stroma rohovky chirurgie   MeSH
• transplantace rohovky * metody   MeSH
• vřed rohovky * chirurgie   MeSH
• vřed chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: To evaluate changes in corneal refractive parameters after implantation of a stromal lenticule of different thickness. We assume that the refractive outcome depends on the optical power of the used lenticule. METHODS: We conducted an ex-vivo non-human study on 33 normotonic porcine eyeballs divided into two groups, for 4D and 8D human lenticule implantation. Corneal stromal lenticules were obtained as a by-product from a laser procedure ReLEx SMILE. We evaluated corneal refractive parameters measured on Oculus Pentacam© device before and immediately after the intrastromal lenticule implantation. RESULTS: There was no statistically significant difference in corneal refractive parameters between the eyeball groups before lenticule implantation. In both groups, the intrastromal implantation in the depth of 300um led to a significant increase of central corneal pachymetry and corneal anterior steepening. In the 4D group the average central corneal pachymetry increased from 903 ± 124.59 to 1230 ± 148.99 (p = 0.0022) and in 8D group from 733.35 ± 69.60 to 1109 ± 161.64 (p = 0.0008). Induced changes in other studied parameters were not statistically significant, Kmax changed from 45.57 ± 2.78 to 72.07 ± 16.83 (p = 0.0094) and Km front from 40.72 ± 1.60 to 48.87 ± 5.83 (p = 0.0037) in 4D group and in the 8D group average Kmax increased from 42.22 ± 1.54 to 62.95 ± 12.67 (p = 0.0001) and K2 front 40.46 ± 1.64 to 51.51 ± 9.63 (p = 0.0037). There were no significant differences in refractive changes between the 4D and 8D groups after lenticule implantation. CONCLUSION: Intrastromal corneal lenticule implantation induces changes in corneal refractive parameters. In both groups, the implantation induced a significant increase of an anterior corneal steepening without any significant influence on posterior corneal flattening. Corneal lenticule implantation did not lead to any significant change of corneal astigmatism. However, in order to have more precise data for future clinical applications we need to continue with the experiments and verify the results on human corneas.

• Klíčová slova
• Corneal lenticule implantation, corneal topography after lenticule implantation, ex-vivo corneal lenticule implantation,
• MeSH
• laserová chirurgie rohovky * metody   MeSH
• lasery excimerové terapeutické užití   MeSH
• lidé MeSH
• nemoci rohovky * MeSH
• prasata MeSH
• refrakce oka MeSH
• rohovka MeSH
• rohovková topografie MeSH
• stroma rohovky chirurgie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: The goal of our study is to find an optimal approach to the preparation and preservation of corneal stromal tissue. We want to compare different methods of corneal stromal tissue creation and storage to optimize the efficacy of this process under the conditions of an eye bank. After we find the most suitable method to create a safe high quality product, we want to prove the possibility of using a single donor cornea for more than one patient. We would also like to verify the feasibility of making more corneal lenticules after the removal of a corneal endothelium for DMEK transplantation. METHODS: We provided morphological (histology, scanning electron microscope) and microbiological analysis in order to compare different methods of corneal lenticule and corneal stromal lamellae preparation and preservation. We also tested the surgical handling of the tissue to secure a safe manipulation of the tissue for clinical use. We compared two methods of corneal lenticule preparation: microkeratome dissection and femtosecond laser. As methods of preservation, we tested hypothermia, cryopreservation at -80 degrees Celsius in DMSO (dimethyl sulfoxide) and storage at room temperature with glycerol. Some intrastromal lenticules and lamellae in each group were previously irradiated with gamma radiation of 25 kGy (KiloGray). RESULTS: Corneal stromal lamellae prepared with a microkeratome have a smoother cut - side surface compared to lamellae prepared with a femtosecond laser. Femtosecond laser preparation caused more irregularities on the surface and we detected more conglomerates of the fibrils, while lamellae made with microkeratome had more sparse network. Using femtosecond laser, we were able to make more than five lenticules from a single donor cornea. Gamma irradiation led to damage of collagen fibrils in corneal stroma and a loss of their regular arrangement. Corneal tissue stored in glycerol showed collagen fibril aggregates and empty spaces between fibrils caused by dehydration. Cryopreserved tissue without previous gamma irradiation showed the most regular structure of the fibrils comparable to storage in hypothermia. CONCLUSION: Our results suggest that formation of a corneal lenticule lamellae by microkeratome results in smoother corneal lenticules, while being much cheaper than formation by femtosecond laser. Gamma irradiation of 25 kGy caused damage of the collagen fibres as well as their network arrangement, which correlated with loss of transparency and stiffer structure. These changes impair possible surgical utilisation of gamma irradiated corneas. Storage in glycerol at room temperature and cryopreservation had similar outcomes and we believe that both methods are appropriate and safe for further clinical use .

• Klíčová slova
• Corneal lenticule implantation, Corneal stromal lamella, Corneal tissue cryopreservation, Corneal tissue gamma-irradiation, Corneal tissue preparation, Effective corneal tissue utilization,
• MeSH
• dimethylsulfoxid MeSH
• glycerol * MeSH
• hypotermie * MeSH
• kolagen MeSH
• lidé MeSH
• rohovka chirurgie   MeSH
• stroma rohovky chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• dimethylsulfoxid MeSH
• glycerol * MeSH
• kolagen MeSH

Corneal stromal lenticule is a part of corneal stroma, which can be created by manual dissection, by femtosecond laser from the donor cornea, but chiefly it is a waste product of a refractive procedure ReLex SMILE (Small Incision Lenticule Extraction). Corneal lenticule has a huge potential in corneal surgery. In recent years, many studies have been published to show the possibility to use this tissue to treat corneal defects, as well as in refractive surgery. Thanks to the quantity of lenticules which arise every day during SMILE operations, this tissue is much more accessible than any other kind of corneal tissue. According to the experience with lenticule implantation in animal models, or even human patients, lenticule implantation is considered safe, reversible method, which is not associated with immune rejection or other severe complications. However, the crucial step before the process of lenticule implantation, is proper preservation of this tissue. Donor corneal tissue containing endothelium is usually preserved in hypothermia and then usable maximally for two weeks. Newer methods such as organ culture storage and use of a sterile cornea prolong the time of usability of the tissue. The possibilities for corneal lenticule storage are theoretically wider thanks to the fact, that we do not need to preserve fragile cellular structures. Besides the storage in hypothermia, other preserving methods such as cryopreservation and storage after decellularization have been tested. This review aimed to examine the current literature that describes possible methods of corneal lenticule preservation. A comprehensive search was created based on articles published in English on PubMed.gov, Cochranelibrary.com and Scopus.com using following keywords: corneal lenticule preservation, corneal lenticule storage, cold storage corneal lenticule, corneal lenticule cryopreservation till 2020.

• Klíčová slova
• Cold storage corneal lenticule, Corneal lenticule cryopreservation, Corneal lenticule implantation, Corneal lenticule preservation, Corneal lenticule storage, Keratophakia,
• MeSH
• hypotermie * MeSH
• kryoprezervace MeSH
• lidé MeSH
• rohovka chirurgie   MeSH
• rohovkový endotel MeSH
• stroma rohovky * chirurgie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: To evaluate the long-term results of combining cataract surgery, intraocular lens (IOL) implantation, and Descemet membrane endothelial keratoplasty with peripheral stromal support (DMEK-S). METHODS: The outcomes of 107 eyes of 37 patients who had undergone a combination of cataract surgery, IOL implantation, and DMEK-S between October 2007 and February 2015 were retrospectively evaluated. The average follow-up duration was 18.2 ± 18.3 months (range, 6-84 months). Changes in uncorrected and corrected distance visual acuity, spherical equivalent, and corneal endothelial cell density were analyzed. Intraoperative and postoperative complications were also recorded. RESULTS: The mean logMAR uncorrected distance visual acuity improved from 0.92 ± 0.60 preoperatively to 0.33 ± 0.33, 0.28 ± 0.25, 0.24 ± 0.20, and 0.27 ± 0.27 at 6, 12, 24, and 36 months postoperatively (P < 0.001), respectively. The mean logMAR corrected distance visual acuity improved from 0.62 ± 0.65 preoperatively to 0.17 ± 0.29, 0.13 ± 0.21, 0.07 ± 0.16, and 0.11 ± 0.23 at 6, 12, 24, and 36 months postoperatively (P < 0.001), respectively. The mean endothelial cell density decreases were 50.7% ± 21.1%, 50.8% ± 19.8%, 60.7% ± 16.6%, 62.2% ± 11.8%, and 61.8% ± 20.0% at 6, 12, 24, 36, and 48 months after surgery, respectively. Similar trends, although with slightly better visual outcomes, were found in the subgroup of patients without other eye diseases. The mean final deviation from intended spherical equivalent was 0.77 ± 1.19 D, representing a hyperopic shift. CONCLUSIONS: A combined procedure of cataract surgery, IOL implantation, and DMEK-S is an effective method of treatment in patients with combined corneal disease and cataract, maintaining visual rehabilitation in the long term. Future developments should be performed to minimize the incidence of complications.

• MeSH
• fakoemulzifikace * MeSH
• implantace nitrooční čočky MeSH
• katarakta komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• nemoci rohovky komplikace   MeSH
• počet buněk MeSH
• poruchy zraku rehabilitace   MeSH
• retrospektivní studie MeSH
• rohovkový endotel patologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stroma rohovky chirurgie   MeSH
• úbytek endoteliálních buněk rohovky patofyziologie   MeSH
• výsledek terapie MeSH
• zadní lamelární keratoplastika * MeSH
• zraková ostrost fyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: To evaluate the outcomes of the hybrid technique of posterior lamellar keratoplasty (Descemets' membrane endothelial keratoplasty with stromal rim, DMEK-S) in eyes with multiple ocular pathologies. METHODS: A retrospective case control study of the consecutive group of all eyes with combined ocular pathologies which underwent DMEK-S keratoplasty. We evaluated the number of pre- and post-operative complications; uncorrected distance visual acuity (UDVA); corrected distance visual acuity (CDVA) and endothelial cell density (ECD). The first group (Group 1 - 100 eyes) was compared to a control group of eyes (Group 2 - 145 eyes) without combined ocular pathologies, which were operated throughout the same time period. Comparisons were made in the 12th month of the follow-up. RESULTS: Both the UDVA and the CDVA statistical values 12 months after the surgery were significantly better in Group 2. ECD was comparable in both groups. The number of complications during surgery was considerably higher in Group 1, where a certain type of complication occurred in 15 eyes (15%), while in Group 2 this complication occurred only in 9 eyes (6.2%). In Group 1 a slightly higher number of rebubbling cases (52% vs. 48.3%) occurred, as well as more than twice as many cases of primary graft failure (34% vs. 15.7%) compared to Group 2. CONCLUSION: DMEK-S - hybrid endothelial transplantation in complicated eyes in the evaluated group of patients led to a noticeable improvement of visual acuity. When compared to surgeries in uncomplicated eyes, DMEK-S results in a higher rate of postoperative complications, especially graft detachment and primary failure.

• Klíčová slova
• DMEK-S, endothelial dystrophy, endothelial transplantation, lamellar keratoplasty,
• MeSH
• Descemetova membrána chirurgie   MeSH
• dospělí MeSH
• endoteliální buňky transplantace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• oční hypertenze etiologie   MeSH
• oční nemoci chirurgie   MeSH
• pooperační komplikace etiologie   MeSH
• přežívání štěpu MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stroma rohovky chirurgie   MeSH
• studie případů a kontrol MeSH
• transplantace rohovky metody   MeSH
• výsledek terapie MeSH
• zraková ostrost fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH

UNLABELLED: Introduction: The intrastromal corneal ring segments implantation is widely used as an effective method for keratoconus correction. Femtosecond laser technology represents very precise and modern approach in corneal tunnel creation. Nevertheless complication like an extrusion of the implanted ring segment rarely appears. There are few different types of intrastromal corneal segments available. Keraring (Mediphacos Ltd.) is primary designed for keratoconus treatment. MATERIALS AND METHODS: We evaluated results of the Keraring implantations in 32 patients (48 eyes) with keratoconus or with marginal pellucid degeneration. We implanted 78 segments totally in the period from January 2015 to February 2017, with the assistance of femtosecond laser. We present our data collected after the 6 months follow up. Uncorrected visual acuity - UCVA and best corrected visual acuity - BCVA were evaluated. We scored the changes in the subjective and objective refraction. The complications were observed. RESULTS: Preoperative UCVA was in 44 (91,60%) eyes under or equal 0,3. Postoperative UCVA after 6 months was in 29 (60,41%) eyes over or equal 0,3. Visual acuity improved in 38 (79,16%) eyes totally with the gain of 1 to 9 lines, BCVA improved in 27 (56,25%) eyes and in 15 (31,25%) eyes stayed postoperatively unchanged. There was reduction of the spherical equivalent (SE), in the subjective and objective refraction. In our group there we detected 9 (18,75%) extrusions of the implanted ring segment, which occurred on average 7,3 months (range 2/ 16 months) after the surgery. CONCLUSION: Intrastromal corneal ring segments implantation with the femtosecond laser assistance is an effective approach in the keratoconus treatment. Complications are not often observed. With careful selection of the suitable patient it is possible to avoid them. Key words: keratoconus, intrastromal corneal ring segments, femtosecond laser.

• Klíčová slova
• femtosecond laser, intrastromal corneal ring segments, keratoconus,
• MeSH
• implantace protézy * MeSH
• keratokonus * chirurgie   MeSH
• laserová terapie * MeSH
• lidé MeSH
• protézy a implantáty MeSH
• refrakce oka MeSH
• rohovková topografie * MeSH
• stroma rohovky * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: to present one and two years clinical results after intrastromal continuous corneal ring implantation in keratoconus patients. METHODS: Retrospective evaluation of the results of patients with keratoconus, after MyoRing implantation for improving of visual functions. The uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (CDVA), the residual subjective refractive error, pachymetry, keratometry and the size of corneal astigmatismus were evaluated. Peroperative and postoperative complications were investigated. The minimal follow-up time was 12 months. RESULTS: The study included 32 eyes of 30 patients with mean age of 30.08 (± 11.56) years. UDVA improved from 1.03 (± 0.41) logMAR to 0.36 (± 0.25) logMAR 12 months and 0.31 (± 0.27) logMAR 24 months after surgery. These changes were stastistically significant. The maxima value of corneal curvature (Kmax) was preoperatively 52.48 (± 6.35) D, 46.08 (± 4.44) D 12 months and 45.53 (± 5.52) D 24 months after surgery. Both changes were statistically significant (P ˂ 0,00000). The mean value of corneal curvature (K mean) was preoperatively 50.10 (± 4.96) D, 44.25 (± 4.40) D 12 months and 44.11 (± 5.38) D 24 months after surgery. Both changes were statistically significant. In any of the patients we did not register any severe peroperative or postoperative complication. CONCLUSION: The MyoRing implantation is an effective and safe method in improvement of visual functions in keratoconus patients. Clinical results are stable in one and two years follow-up time.

• MeSH
• dospělí MeSH
• keratokonus chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• protézy - design MeSH
• protézy a implantáty * MeSH
• retrospektivní studie MeSH
• rohovková topografie MeSH
• stroma rohovky patologie   chirurgie   MeSH
• zraková ostrost * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

To assess the quantitative and qualitative parameters of pre-cut posterior corneal lamellae for Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) prepared manually in the Ocular Tissue Bank Prague. All 65 successfully prepared pre-cut posterior corneal lamellae provided for grafting during a 2-year period were analyzed retrospectively. The lamellae, consisting of a central zone of endothelium-Descemet membrane surrounded by a supporting peripheral stromal rim, were prepared manually from corneoscleral buttons having an endothelial cell density higher than 2,500 cells/mm(2). The live endothelial cell density, the percentage of dead cells, the hexagonality and the coefficient of variation were assessed before and immediately after preparation as well as after 2 days of organ culture storage at 31 °C. Altogether, the endothelium of 57 lamellae was assessed. Immediately after preparation, the mean live endothelial cell density was 2,835 cells/mm(2) and, on average, 1.8 % of dead cells were found. After 2 days of storage, the cell density decreased significantly to 2,757 cells/mm(2) and the percentage of dead cells to 1.0 %. There was a significant change in the mean hexagonality and the coefficient of variation after lamellar preparation and subsequent storage. The amount of tissue wasted during the preparation was 23 %. The endothelial cell density of posterior corneal lamellae sent for DMEK-S was higher than 2,700 cells/mm(2) in average with a low percentage of dead cells; 65 pre-cut tissues were used for grafting during a 2-year period.

• MeSH
• apoptóza MeSH
• Descemetova membrána cytologie   chirurgie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci rohovky chirurgie   MeSH
• oční banky MeSH
• počet buněk MeSH
• retrospektivní studie MeSH
• rohovka cytologie   chirurgie   MeSH
• rohovkový endotel cytologie   chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stroma rohovky cytologie   chirurgie   MeSH
• techniky tkáňových kultur metody   MeSH
• zadní lamelární keratoplastika metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• práce podpořená grantem MeSH

A 20-year-old patient, diagnosed with posterior polymorphous corneal dystrophy, developed corneal edema for which he underwent Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) in the right eye. No intra- or postoperative complications were noted. At the last follow-up 2 years and 9 months after the procedure, the best corrected visual acuity was 1.0 and endothelial cell density declined from 3533 cells/mm 2 to 1012 cells/mm 2 . Despite the endothelial cell loss, DMEK-S appears to be a good alternative to other surgical techniques for the treatment of corneal endotheliopathies, and it may be of benefit to young patients.

• MeSH
• časové faktory MeSH
• Descemetova membrána patologie   chirurgie   MeSH
• Fuchsova endoteliální dystrofie patologie   chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• následné studie MeSH
• rohovkový endotel patologie   chirurgie   MeSH
• stroma rohovky patologie   chirurgie   MeSH
• zadní lamelární keratoplastika metody   MeSH
• zraková ostrost MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH