Purpose To present our experience with post-traumatic lens dislocation management by vitrectomy followed with sutureless artificial lens fixation. Methods The retrospective study involved 15 patients (12 men and 3 women) aged from 36 to 78 (on average, 63 years old), from the Vitreoretinal Surgery Teaching Hospital, operated in the years 2013-2015. All cases concerned ocular traumas with dislocation of the natural or artificial lens to the anterior chamber, vitreous body chamber, or posttraumatic aphakia. After vitrectomy, patients had the implant fixated with a technique devised by Scharioth-sutureless fixation of posterior chamber implants in the groove area, with haptics placed in scleral tunnels parallel to the corneal limbus. Preoperative and postoperative condition of the eye was assessed.Results The average period of observation was 29 weeks. Average pre-surgery refraction was ? 10.75, while post-surgery ? 1.25. Average bestcorrected visual acuity in Snellen charts before surgery was 0.3 and at the end of the observation period 0.5. The improvement in visual acuity after surgery in relation to visual acuity before surgery was statistically significant (P = 0.005). In the first 2 weeks after surgery, minor hypotonia was observed in three of the patients, while in two-moderate bleeding to the vitreous body and the anterior chamber, which subsided without surgical intervention. A slight decentration of the implant observed in two cases did not affect later refraction or BCVA. Conclusion Basing on the abovementioned facts, we believe that this surgical approach facilitates the fixation of the dislocated lens and allows a successful treatment of secondary implantation or repositioning of a dislocated intraocular lens.

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Within the corneal limbal epithelium there exist limbal stem cells (LSC) which under suitable conditions can regenerate their population or differentiate into corneal epithelial cells. However, upon limbal damage, the cells differentiate irreversibly and do not self-renew. One of the causes of the damage of progenitor cells and their niche is a long-term use of eye drops containing preservatives. While the side effects are related to the antimicrobial activity of such eye drops, damage to cellular and cytoplasmic membranes as well as enzymatic reactions can concurrently cause disorders of normal ocular surface tissue. The aim of this study was to evaluate the toxic effects of the preservative used in eye drops -benzalkonium chloride (BAK) -on human corneal limbal epithelial cells in vitro, and to define the mechanisms of acute limbal cell damage caused by the action of BAK. Ten corneoscleras rims, which were not qualified for transplantation by the Eye Tissue Bank, were obtained from 5 deceased donors aged 39 to 43 years. The tissue fragments (explants) containing corneal limbal epithelial cells were immediately after the explantation subjected to the action of the experimental substance being benzalkonium chloride (BAK) in concentrations of 0.005% and 0.01%. The qualitative analysis of microscopic images of the corneal limbus specimens was performed on tissue sections stained with hematoxylin and eosin using the immunohistochemical method for vimentin and with the use of a transmission electron microscope. The structure of the area of corneal limbus, as well as the morphological characteristics and the ultrastructure of the very limbal cells were evaluated with careful attention to the basal epithelial cells of the limbus. The BAK-treated groups of explants in sections stained by H & E featured characteristics of severe structural disorders of the corneal limbus area. Depletion of the epithelial cells was visible and involved both superficial and deep layers. Immunohistochemical staining for vimentin did not show the expression of this protein. This might have been connected with the damage to the cytoskeleton of limbal epithelial cells and large depletion of cells reaching down to the basement membrane. The images obtained with electron microscopy demonstrate serious defects of cell ultrastructure and, indirectly, abnormal cellular metabolism, including water and electrolyte balance and energy metabolism.This experiment confirmed the significant adverse effect of benzalkonium chloride on the limbal epithelial cells and the possibility of their damage.

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