Biomedical subjects
Publications and source records attributed to E Iwaszkiewicz.
Presented are personal observations of 5 patients after corneal grafting who exhibited signs of graft disease in the course of epidemic keratoconjunctivitis in Autumn 1987. Clinical signs and methods of procedure are discussed. In one case the graft partially opacified due to an additional trauma.
By means of a Digilab pneumotonometer the author determined every 2 hours (from 7 a.m. till 10 p.m.) the IOP in 73 eyes of 37 patients with a keratoconus; there were 25 men and 12 women aged 16 to 40 years. The mean upper value for the R. eye amounted 19.243 +/- 2.842 mm Hg, for the L. eye 18.056 +/- 2.797 mm Hg. The means oscillation of the IOP in a day equalized 7.000 +/- 2.415 mm Hg in the R. eye and 6.000 +/- 2.378 mm Hg in the L. eye.
A 0.5% Timoptic was used in 37 patients with a keratoconus during 2 weeks, one drop twice a day to both eyes; the day measurements of the intraocular pressure were subsequently repeated. The mean upper value of P after drops was 14.595 +/- 2.522 mm Hg for the R. eye and 14.139 +/- 2.113 mm Hg for the L. eye. The mean day oscillations in the R. eye amounted 3.378 +/- 1.441 mm Hg and in the L. eye 3.333 +/- 1.042 mm Hg. The differences in daily oscillations of P before and after drops were statistically significant. After excluding from the analysis 4 patients who did not react to Timoptic one compared 12 eyes in which the objective improvement was evident with 21 eyes without improvement. These two groups differed in respect of daily oscillations of P before application of the drops--p less than 0.004.
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The discussion on this topic was considered as advisable because of frequent diagnostic faults and an incorrect treatment of keratoconus. The authors presents the diagnosis, foundations of the general and topical treatment of keratoconus.
The study presents conditions mostly described as co-existing with the keratoconus in 7 patients (from among 300 examined) born from an uni-ovular twin pregnancy. Only one pair of twins showed keratoconus of both eyes and developing identically in both eyes.
On examining about 300 patients with keratoconus in the period of 20 years the authors detected in a number of cases variations of the intraocular pressure. By means of a pneumo-tonometer Digilab 30R periodic variations of the IOP were measured in 76 patients and daily variations in 42. The statistical analysis showed that the application of Timolol and reduction of the IOP variations has a decisive influence on the improvement of objective changes and the visual acuity without correction. Presently in our Department Timolol is used successfully in 160 patients. There was no deterioration in either patient at that time and many patients showed an improvement of the condition of keratoconus.
One of the main problems of corneal transplantation is the postoperative astigmatism. In the last period the intraoperative application of the kerato-scope, new type of needles and threads in stitching the corneal patch created a chance for solving this problem. The authors present the methods used for stitching of the corneal patch, their advantages and the defects with consideration of differences resulting from the thickness and kind of the thread, from the length and form of the needle. Basing on personal experience and data from the literature they propose the technique of the suture which they are using.
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In the period of 1985-1992 we performed in our centres 34 operations of a double procedure and 12 operations of a triple procedure. During the observation--from 2 months to 7 years--we obtained favourable results encouraging to connect the corneal grafting with cataract extraction in high myopia and with extracapsular cataract extraction with implantation of an artificial lens in emmetropic eyes. Presented is the appropriate technique of operation and the results obtained.
Eleven re-transplantations of the cornea were performed between October 1988 and October 1991. Utilized was the material selected according to a partial compatibility of the HLA factor in 11 men with opacified transplants performed previously without antigen selection in high risk leukoma (in 10 cases after severe eye burns). In 3 patients the transplant was the fifth one, in 1 patient the fourth, in two--the third and in 5 the second one. Favourable results (transparent and semi-transparent grafts) were obtained in 8 patients (72.7 p.c.).
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Ten corneae from donors selected in respect of partial compatibility of the HLA antigens were transplanted in the period October 1988--October 1989. The grafting was performed in 10 patients with leukomas included in the group of maximal risk (5+). In 9 patients the leukomas were due to ocular burns (chemical in 8 patients and thermal in 1 patient). In 1 patient, a 74 years old man the grafting was performed in the single eye with Salzman's corneal dystrophy with a simultaneous cataract extraction. During observation, which lasted 2 to 12 months 6 grafts remained transparent, 1--partly opacified. Not any transplant did totally opacify.
Fifteen corneal grafts were performed in 15 men with high risk leukoma (5+) in the period October 1988--November 1990. The age of the patients oscillated between 11 and 76 years. In 5 patients the grafting was done in only eye. The period of observation after surgery amounted 4-29 months. The favourable results (transparent and ++semi-transparent grafts) were obtained in 9 eyes (60 p.c.) and partly opacified grafts in 6 (40 p.c.). Neither of the grafts opacified. In the preceding years--without taking into account the antigenic selection of the donor--favourable results in similar leukoma cases were achieved in ca. 42 p.c. of cases.
Two hundred and fifty three patients with keratoconus (161 men and 92 women) have been observed in the period 1968-1988. Selected epidemiological data are presented; between others: the distribution in Poland, education of the patients, the time of onset and the time of diagnosis of the condition.