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

Traumatic globe rupture after deep anterior lamellar keratoplasty

We report a case of traumatic globe rupture following blunt trauma in the left eye of a 20-year-old male who had undergone deep anterior lamellar keratoplasty for keratoconus. Extrusion of the crystalline lens and prolapse of vitreous through the inferior 180&#x00B0; donor host junction was noted. After the repositioning of the graft, anterior vitrectomy and repair of graft host junction, the graft regained clarity in eight weeks with good visual recovery

Outcome of posterior chamber phakic intraocular lens procedure to correct myopia

AbstractPurposeTo assess the safety and efficacy of the implantable contact lens (ICL™) to treat myopia.DesignClinical, retrospective, single center, non-randomized case series.ParticipantsSixty-nine eyes of 46 patients with myopia ranging from −3.00 to 25.00D were included in this study.InterventionImplantation of the ICL™.Main outcome measuresUncorrected Visual Acuity (UCVA), refraction, best spectacle corrected visual acuity (BSCVA), adverse events, operative and postoperative complications, subjective assessment and symptoms.ResultsThe mean follow-up was 12.35±6.13 (SD) months (range, 6months–32months). At the last visit, 49.20% of eyes had 20/20 or better UCVA compared to preoperative 20/20 or better BSCVA of 31.9% of eyes; 69.23% of eyes had postoperative UCVA better than or equal to preoperative BSCVA. The mean manifest refractive cylinder was 1.93±1.21D at baseline and 1.00±0.92D postoperatively. The mean manifest refraction spherical equivalent (MRSE) was −11.70±4.24D preoperatively and −0.69±1.13D postoperatively. A total of 69.8% of eyes were within ±0.5D of the predicted MRSE; 84.1% were within ±1.0D, and 88.90% were within ±2.0D. BSCVA of 20/20 or better was achieved in 64.6% of eyes postoperatively, compared to 31.9% preoperatively. Mean improvement in BSCVA was 1line. One eye (1.5%) lost ⩾2 lines of BSCVA at the last visit, whereas 20% of eyes improved by ⩾2 lines. A total of 56.92% of cases gained ⩾1 line of BSCVA and 4.62% of cases lost ⩾1 line. Four ICL lenses were removed without significant loss of BSCVA, and 2 eyes with clinically significant lens opacities were observed. Four eyes (5.8%) developed a pupillary block the first day postoperatively. One eye (1.4%) developed a hypotony and AC shallowing.ConclusionImplantation of ICL for the correction of myopia was a safe procedure with good visual and refractive results from the early postoperative period to 1year. Long-term follow-up is required to confirm the long-term safety of this implant

Deep anterior lamellar Keratoplasty

AbstractKeratoconus is a disease causing increased steepening of the cornea resulted in irregular astigmatism. Treatment options are Glasses, Hard contact lenses, Cross linking, Intracorneal Segments insertion, Refractive surgery (Gilda et al., 2008), or Keratoplasty. Lamellar Keratoplasty (LKP) can be a better choice to manage cases of moderate and some cases of severe Keratoconus without deep scarring and severe thinning, also in cases of corneal scarring not involving the deeper layers of the cornea. LKP is a corneal graft technique consisting of transplantation of partial-thickness donor tissue, devoid of endothelium, Descemet membrane (DM), and rear stroma into a recipient healthy stromal bed after dissection of pathologic anterior stroma. However, deep lamellar Keratoplasty (DLKP) is a surgical method that completely removes pathologic corneal stroma tissue down to the DM, followed by transplantation of donor cornea without endothelium over the host bed. DLKP has a number of advantages over penetrating Keratoplasty (PKP). Because it does not violate the intraocular structures of the eye, it diminishes or eliminates the chance of postoperative glaucoma, cataract formation, retinal detachment, cystoids macular edema, expulsive choroidal hemorrhage and epithelial ingrowths. Furthermore, this procedure avoids the replacement of host endothelium with donor endothelium and thus precludes endothelial graft rejection, with comparable visual outcomes and low rate of chronic endothelial cell loss compared to PKP

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