New INTACS SK implantation in patients with post-laser in situ keratomileusis corneal ectasia.

In this case series, 2 patients with post-laser in situ keratomileusis corneal ectasia were included. Patients were treated with new intrastromal corneal ring segments, INTACS SK (severe keratoconus or steep "K") (Addition Technology, Inc, Des Plaines, IL) implantation. Two segments were inserted without any intraoperative or postoperative complications. Three months after the procedure, uncorrected visual acuity was improved in both patients from counting fingers preoperatively to 20/40 and 20/50, respectively. Best spectacle-corrected visual acuity improved from 20/40 to 20/32 and from 20/50 to 20/40. Manifest refraction improved from -8.75/-5.00 x 125 and -14.25/-6.50 x 33 preoperatively to -5.50/-2.25 x 125 and -8.25/-1.50 x 15 with an improvement in topographic findings. One year postoperatively, uncorrected visual acuity, best spectacle-corrected visual acuity, and topographic findings remained improved. In conclusion, new INTACS SK might be able to improve visual acuity in patients with post-laser in situ keratomileusis corneal ectasia

Treatment of chronic dry eye: focus on cyclosporine.

To review the current treatment of chronic dry eye syndrome, focusing on cyclosporine A (CsA), a systematic literature search was performed using PubMed databases in two steps. The first step was oriented to articles published for dry eye. The second step was focused on the use of CsA in dry eye. A manual literature search was also undertaken based on citations in the published articles. The knowledge on the pathogenesis of dry eye syndrome has changed dramatically during the last few years. Inflammation and the interruption of the inflammatory cascade seem to be the main focus of the ophthalmologic community in the treatment of dry eye, giving the anti-inflammatory therapy a new critical role. The infiltration of T-cells in the conjuctiva tissue and the presence of cytokines and proteasis in the tear fluid were the main reason introducing the use of immunomodulator agents such as corticosteroids, cyclosporine, and doxycicline in order to treat dry eye syndrome. CsA emulsion is approved by the FDA for the treatment of dry eye, while clinical trials of this agent have demonstrated efficacy and safety of CsA. CsA seems to be a promising treatment against dry eye disease. New agents focused on the inflammatory pathogenesis of this syndrome in combination with CsA may be the future in the quest of treating dry eye. More studies are needed to determine the efficacy, safety, timing, and relative cost/effect of CsA

Fifteen-year follow-up after LASIK: case report.

To present 15-year follow-up of one of the first LASIK-treated patients. A 40-year-old woman underwent LASIK in the left eye for myopia in July 1991. Fifteen years after LASIK, spherical equivalent error was statistically significantly reduced from preoperative -8.75 -3.75 x 025 degrees to postoperative -4.25 -2.75 x 010 degrees. Six months postoperatively, refractive and topographic stability was obtained and remained stable during follow-up with no significant changes between interval mean time (-3.75 -3.00 x 020 degrees 6 months postoperatively to -4.25 -2.75 x 010 degrees 15 years postoperatively). No early or late postoperative complications were observed, and confocal microscopy revealed a regenerated nerve plexus and normal cornea. However, increased scattering and presence of debris were observed at the flap interface even after 15 years. Despite moderate predictability (residual refractive error) and small optical zone, the patient was satisfied with final outcome. One of the first LASIK-treated patients was presented 15 years after surgery. LASIK in this patient had low predictability, although refractive and topographic stability occurred after the sixth postoperative month. No long-term, sight-threatening complications were identified during follow-up

Idiopathic recurrence of diffuse lamellar keratitis after LASIK.

To report a case of late recurrence of bilateral diffuse lamellar keratitis (DLK) after LASIK. A 39-year-old woman presented in the early postoperative period with bilateral DLK after hyperopic LASIK and was treated with topical steroids. One year after and with no obvious cause (idiopathic), recurrence of the same stage (stage III) of disease was observed. Slit-lamp examination revealed diffuse, multifocal, and granular haze in the interface. The microbiology culture was negative. Confocal microscopy demonstrated multiple activated keratocytes, debris, and inflammatory cells adjacent to the flap interface. After intense treatment with topical corticosteroids, DLK resolved and corneal transparency was achieved with complete restoration of visual acuity. Diffuse lamellar keratitis may recur in LASIK patients with previous episodes without an obvious cause (idiopathic). Early diagnosis and treatment with topical corticosteroids can achieve complete resolution without visual loss--even in advanced stages of DLK

Single intrastromal corneal ring segment implantation using the femtosecond laser after radial keratotomy in a keratoconic patient.

A 33-year-old woman with irregular astigmatism 6 years after radial keratotomy (RK) for keratoconus was treated with implantation of a single intrastromal corneal ring segment (Keraring) using the femtosecond laser. The segment (0.150 mm thick with a 160-degree arc) was inserted in the steepest area (inferior) with no intraoperative or postoperative complications. Six months postoperatively, the uncorrected visual acuity had improved from 20/40 to 20/25 and the best spectacle-corrected visual acuity, from 20/32 to 20/20. The mean manifest astigmatic correction decreased from -2.50 diopters (D) to -0.75 D, and corneal topography showed improved inferior steepening and less irregular astigmatism. Although the results are encouraging, the long-term effect of this approach in post-RK patients is not known

Femtosecond laser-assisted corneal pocket creation using a mask for inlay implantation.

To describe the technique of femtosecond laser-assisted intracorneal pocket creation, using a mask for the implantation of a corneal inlay in the non-dominant eye of a 56-year-old, emmetropic, presbyopic woman for the correction of presbyopia. Using the iFlap treatment-type software of the femtosecond laser (IntraLase 150, Abbott Medical Optics), a full lamellar cut was created at 280-μm depth. A keyhole-shaped mask was placed at the internal part of the glass of the applanation cone. A separator was used to separate the stroma, and an inserter was used to implant the inlay at the center of the line of sight. To determine the line of sight, the microscope and centration system of the excimer laser (Allegretto Wave 400 Hz, WaveLight Laser Technologie AG) were used. The Flexivue Microlens inlay (Presbia) was implanted. No intra- or postoperative complications occurred during follow-up. Uncorrected near visual acuity improved from 20/50 to 20/20 at the first postoperative week. Femtosecond-assisted intracorneal pocket creation using a mask is a simple, safe, and efficient approach for the implantation of corneal inlays

Photorefractive keratectomy in a patient with epithelial basement membrane dystrophy.

To report a case of excimer laser photorefractive keratectomy (PRK) in a patient with epithelial basement membrane dystrophy (EBMD). Interventional case report. A 36-year-old male with clinical manifestations of EBMD underwent bilateral, simultaneous PRK for low myopia correction. A delay (up to 17 days) in the epithelial healing process with unstable epithelium was observed. During the first three postoperative months a visually significant subepithelial haze was developed in both eyes. One year postoperative, an improvement in haze formation and visual acuity in both eyes was found. PRK in patients with EBMD could result in favorable refractive and clinical outcome

Descement's Membrane Detachment Diagnosis Using a Very High Frequency Ultrasound Scanning System.

A 74-year-old woman was referred to our institute due to persistent corneal edema after cataract surgery. Slit-lamp examination revealed severe total corneal edema (obscuring anterior chamber and iris). Using a very high frequency (VHF) ultrasound scanning system (Artemis 2, Ultralink LLC) descement's membrane detachment (DMD) was diagnosed. VHF ultrasound scanning system could be a useful instrument in detecting post-cataract surgery DMD especially in patients in which diagnosis is difficult due to significant corneal clouding

Diffuse lamellar keratitis after corneal crosslinking in a patient with post-laser in situ keratomileusis corneal ectasia.

A 27-year-old man presented with corneal ectasia in his left eye 4 years after myopic laser in situ keratomileusis (LASIK) and was treated with riboflavin-ultraviolet-A (crosslinking). During the first post-treatment days, diffuse lamellar keratitis (DLK) (stage III) developed. The microbiology culture was negative. After intensive treatment with topical corticosteroids, the DLK resolved during the following 2 weeks. Crosslinking for post-LASIK corneal ectasia may induce DLK. Early diagnosis and appropriate treatment with intensive topical corticosteroids is essential to successfully manage this post-crosslinking complication

Intrastromal corneal ring segment implantation with the femtosecond laser in a post-keratoplasty patient with recurrent keratoconus.

A 50-year-old woman had implantation of intrastromal corneal ring segments for recurrent keratoconus 15 years after penetrating keratoplasty. Two segments (0.15 mm and 0.25 mm) were inserted without any intraoperative or postoperative complications, using the femtosecond laser to create the tunnels (superior and inferior). Ten months after the procedure, the uncorrected visual acuity was 20/100, compared with counting fingers preoperatively, and the best spectacle-corrected visual acuity improved from 20/63 to 20/32. Although the results are encouraging, the long-term effect of this approach for the management of post-keratoplasty patients with recurrent keratoconus is not known