Deep anterior lamellar keratoplasty for pellucid marginal degeneration

AbstractPurposeTo present the surgical outcomes of deep anterior lamellar keratoplasty (DALK) for pellucid marginal degeneration (PMD).MethodsA retrospective review was performed in 16 eyes of 16 patients who underwent DALK at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between January 1, 2006 and December 30, 2009. Baring of Descemet’s membrane (DM) during DALK was achieved in 8 (50%) eyes; residual stroma was left intraoperatively in the remaining 8 (50%) eyes. The big bubble technique was performed in 10 (62.5%) eyes and manual dissection was performed in the remaining 6 (37.5%) eyes. Visual acuity (LogMAR notation), intraocular pressure, intraoperative complications and postoperative graft status were assessed.ResultsThe mean follow up was 14.6±8.2months (range 6–35months). The mean overall age was 31.4±9.6years (range, 19–50years). Visual acuity increased statistically significantly from 0.9±0.3 (range 0.5–1.6) preoperatively to 0.4±0.2 (range 0.0–0.7) at last follow-up (p<0.0001). There was a statistically significant improvement in postoperative sphere, cylinder, and spherical equivalent (p<0.035, p<0.001, and p<0.02, respectively) compared to preoperative. Postoperative visual acuity was not statistically significantly related to gender, type of surgical technique, and baring or perforation of DM. The main graft-related complication was graft–host vascularization (2/16 eyes).ConclusionDALK reduces severe corneal astigmatism and results in good visual and refractive outcomes and is an effective alternative for patients with PMD

Early Ahmed Glaucoma Valve Implantation after Penetrating Keratoplasty Leads to Better Outcomes in an Asian Population with Preexisting Glaucoma

To evaluate the efficacy of Ahmed Glaucoma Valve (AGV) surgery and the optimal interval between penetrating keratoplasty (PKP) and AGV implantation in a population of Asian patients with preexisting glaucoma who underwent PKP.In total, 45 eyes of 45 patients were included in this retrospective chart review. The final intraocular pressures (IOPs), graft survival rate, and changes in visual acuity were assessed to evaluate the outcomes of AGV implantations in eyes in which AGV implantation occurred within 1 month of post-PKP IOP elevation (Group 1) and in eyes in which AGV implantation took place more than 1 month after the post-PKP IOP evaluation (Group 2). Factors that were associated with graft failure were analyzed, and the overall patterns of complications were reviewed. By their final follow-up visits, 58% of the patients had been successfully treated for glaucoma. After the operation, there were no statistically significant differences between the groups with respect to graft survival (p = 0.98), but significant differences for IOP control (p = 0.049) and the maintenance of visual acuity (VA) (p<0.05) were observed. One year after surgery, the success rates of IOP control in Group 1 and Group 2 were 80% and 46.7%, respectively, and these rates fell to 70% and 37.3%, respectively, by 2 years. Factors that were associated with a high risk of AGV failure were a diagnosis of preexisting angle-closure glaucoma, a history of previous PKP, and a preoperative IOP that was >21 mm Hg. The most common surgical complication, aside from graft failure, was hyphema.Early AGV implantation results in a higher probability of AGV survival and a better VA outcome without increasing the risk of corneal graft failure as a result of post-PKP glaucoma drainage tube implantation

Presumed stromal graft rejection after automated lamellar therapeutic keratoplasty: case report

PURPOSE: To describe the development of presumed immune-mediated stromal rejection after automated lamellar therapeutic keratoplasty (ALTK) and its reversal after initiation of intensive topical corticosteroid therapy. METHODS: Observational case report. RESULTS: Stromal edema localized in the graft developed 42 days after ALTK for Avellino corneal dystrophy in a 65-year-old man. After one week of intensive topical corticosteroids, complete reversal of graft edema occurred, with full recovery of visual function. CONCLUSION: The clinical appearance and response to therapy in this case supported the diagnosis of immune-mediated stromal rejection. Ophthalmologists should be aware that stromal rejection may occur in lamellar corneal grafts

Endophthalmitis associated with the Ahmed glaucoma valve implant

Aim: To investigate the rate, risk factors, clinical course, and treatment outcomes of endophthalmitis following glaucoma drainage implant (GDI) surgery. Methods: A computerised relational database search was conducted to identify all patients who were implanted with Ahmed glaucoma valve (AGV) and developed endophthalmitis following surgery at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, between 1 January 1994 and 30 November 2003. Only medical records of the patients who developed endophthalmitis were retrospectively reviewed. Results: 542 eyes of 505 patients who were on active follow up were included in the study. Endophthalmitis developed in nine (1.7%) eyes; the rate was five times higher in children than in adults. Delayed endophthalmitis (developed 6 weeks after surgery) occurred in eight of nine eyes. Conjunctival erosion overlying the AGV tube was present in six of nine eyes. Common organisms isolated in the vitreous included Haemophilus influenzae and Streptococcus species. Multiple regression analysis revealed that younger age and conjunctival erosion over the tube were significant risk factors associated with endophthalmitis. Conclusion: Endophthalmitis is a rare complication of GDI surgery that appears to be more common in children. Conjunctival dehiscence over the GDI tube seems to represent a major risk factor for endophthalmitis. Prompt surgical revision of an exposed GDI tube is highly recommended

Nodular episcleritis in a young patient

1 Department of Ophthalmology, College of Medicine, King Saud University, Riyadh; and 2 Glaucoma Division; 3 Department of Pathology, King Khaled Eye Specialist Hospital; 4 Department of Ophthalmology, Assir Central Hospital, Abha; 5Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.Purpose: To report a case of nodular episcleritis at the limbus associated with corneal deposits in a young patient. Methods: Observational case report. Results: A 16-year-old Saudi girl developed a pinkish-white, soft, well-demarcated mass, 6 x 5 mm in size and 1 mm in height, in the superonasal limbal area of the right eye. It was associated with yellowish deposits in the adjacent cornea. Histopathological evaluation of the excised lesion revealed chronic inflammation in the deep layer of the episclera with infiltration by lymphocytes and epithelioid cells, in addition to capillary proliferation. Subsequently, the patient didn’t develop any systemic manifestation or recurrence during the one-year follow-up period. Conclusion: Although nodular episcleritis tends to occur in an older age group, it can also present in young patients. Surgical excision can result in an excellent clinical outcome