Nine-Year Follow-Up of Intacs Implantation for Keratoconus

To present a case of nine- year bilateral Intacs (Addition Technology, Inc, Fremont, California, USA) implantation for early stage keratoconus. A 25-year-old male underwent bilateral Intacs implantation for the management of keratoconus and hardcontact-lens intolerance (stage 1) in 1999. Nine years postoperatively, spherical equivalent refraction changed from preoperative -0.75 and -2.25 to +0.75 and -1.25 for the right and the left eye, respectively. UCVA was improved from 20/50 to 20/25 in the right and from 20/200 to 20/32 in the left eye. BSCVA of 20/20 in the right eye maintained stable in comparison with the Pre-Intacs BSCVA, while BSCVA was improved from 20/25 to 20/20 in the fellow eye. No early or late complications were observed. Nine years after bilateral Intacs implantation for the management of early stage keratoconus, there was a significant improvement and postoperative stability in patient's visual acuity. No long-term, sight-threatening complications were identified during follow-up

Customized pachymetric guided epithelial debridement for corneal collagen cross linking

<p>Abstract</p> <p>Backround</p> <p>We describe a modified method for deepitheliazation prior to corneal cross linking (CXL). The technique may overcome the current corneal pachymetric limitation parameter (over 400 microns) that is necessary for the safety of the procedure without affecting the overall benefits.</p> <p>Methods</p> <p>In a series of two patients, with inferior topographic steepening and regional thinning (less than 400 microns corresponding to the area of corneal steepening), CXL after customized epithelial removal was performed.</p> <p>Results</p> <p>There were no intra- or postoperative adverse events seen by the nine month follow up examination. Stabilization of the corneal ectasia was observed up to nine months post-costumized pachymetric-guided epithelial removal.</p> <p>Conclusion</p> <p>The technique of customized pachymetric-guided epithelial removal is easy to perform and may overcome the limitations of the preoperative corneal pachymetry expanding the application of the procedure in patients with regional corneal thinning.</p

Clinical Study Long Term Followup of Photorefractive Keratectomy with Adjuvant Use of Mitomycin C

properly cited. Purpose. To study the long term refractive and visual outcomes of photorefractive keratectomy (PRK) with intraoperative application of mitomycin C (MMC). Methods. This study included 37 eyes who received myopic PRK; after photoablation, a sponge soaked in 0.02% MMC solution was applied in all corneas for 2 minutes. Efficacy, safety, predictability, and stability of PRK MMC were evaluated. Endothelial cell density was evaluated at the last postoperative interval. Results. Mean preoperative spherical equivalent (SEQ) was −6.03 ± 1.87 D (diopters) and reduced to −0.09 ± 0.53 D at the last postoperative examination. Mean followup was 44.73 ± 18.24 months. All the eyes were in the ±1.00 D of attempted versus achieved SEQ at the one-year follow-up interval. Furthermore, 95% of the eyes did not lose lines or gained 1 to 2 lines of CDVA, while 5% lost 1 line. At the third postoperative month, 89% of the eyes either were clear or had trace haze, while 4 eyes had mild haze; by the 12-month postoperative interval, none of the eyes demonstrated haze. Mean endothelial cell density (ECD) at the last postoperative interval was 2658 ± 153 cells/mm 2 . Conclusions. PRK, with intraoperative use of MMC, demonstrates stable refractive and visual outcomes up to 44 months after surgery

Application of a hydrogel ocular sealant to avoid recurrence of epithelial ingrowth after LASIK enhancement

To report a case of clinically significant epithelial ingrowth after LASIK that was successfully treated with a hydrogel ocular sealant in combination with flap lifting and scraping technique. Case report. A 56-year-old woman underwent LASIK and a LASIK enhancement procedure in 2002 and 2012, respectively. Six months after the enhancement, visually significant epithelial ingrowth developed in both of her eyes. The left eye was treated with flap lifting, scraping, and suturing, and the right eye was treated with a hydrogel ocular sealant in combination with flap lifting and scraping. No recurrence was evident during a 6-month follow-up period and visual acuity improved in both eyes. No adverse effects were noticed. Recurrent epithelial ingrowth may be successfully avoided with the intraoperative use of a hydrogel ocular sealant combined with flap lifting and scraping. This approach could be used as an alternative to LASIK flap suturing

Management of pediatric keratoconus – Evolving role of corneal collagen cross-linking: An update

Pediatric keratoconus demonstrates several distinctive management issues in comparison with adult keratoconus with respect to under-diagnosis, poor compliance and modifications in treatment patterns. The major concerns comprise of the accelerated progression of the disease in the pediatric age group and management of co-morbidities such as vernal keratoconjuntivitis. Visual impairment in pediatric patients may affect social and educational development and overall negatively impact their quality of life. The treatment algorithm between adults and pediatric keratoconus has been similar; comprising mainly of visual rehabilitation with spectacles, contacts lenses (soft or rigid) and keratoplasty (lamellar or penetrating) depending on the stage of the disease. There is a paradigm shift in the management of keratoconus, a new treatment modality, corneal collagen crosslinking (CXL), has been utilized in adult keratoconic patients halting the progression of the disease. CXL has been utilized for over a 10 year period and based on the evidence of efficacy and safety in the adult population; this treatment has been recently utilized in management of pediatric keratoconus. This article will present an update about current management of pediatric keratoconus with special focus on CXL in this age group

Management of pediatric keratoconus - Evolving role of corneal collagen cross-linking: An update

Pediatric keratoconus demonstrates several distinctive management issues in comparison with adult keratoconus with respect to under-diagnosis, poor compliance and modifications in treatment patterns. The major concerns comprise of the accelerated progression of the disease in the pediatric age group and management of co-morbidities such as vernal keratoconjuntivitis. Visual impairment in pediatric patients may affect social and educational development and overall negatively impact their quality of life. The treatment algorithm between adults and pediatric keratoconus has been similar; comprising mainly of visual rehabilitation with spectacles, contacts lenses (soft or rigid) and keratoplasty (lamellar or penetrating) depending on the stage of the disease. There is a paradigm shift in the management of keratoconus, a new treatment modality, corneal collagen crosslinking (CXL), has been utilized in adult keratoconic patients halting the progression of the disease. CXL has been utilized for over a 10 year period and based on the evidence of efficacy and safety in the adult population; this treatment has been recently utilized in management of pediatric keratoconus. This article will present an update about current management of pediatric keratoconus with special focus on CXL in this age group

Endothelial Cell Loss in Diabetic and Nondiabetic Eyes After Cataract Surgery

To assess and compare the changes in endothelial cell density in diabetic and nondiabetic patients after routine phacoemulsification cataract surgery. Bascom Palmer Eye Institute, Miller School of Medicine, Miami, FL, USA. Retrospective nonrandomized cohort study. This retrospective study included diabetic and nondiabetic patients who underwent phacoemulsification by a single surgeon (K.D.) between September 2013 and March 2016. The main outcome measures were cumulative dissipated energy (CDE) and percentage of endothelial cell loss (ECL). Comparative analysis of CDE and percentage of ECL between the 2 patient groups was performed and then repeated based on the degree of diabetic control (hemoglobin A1c). The study included 66 eyes of 55 diabetic and 67 eyes of 65 nondiabetic patients. Mean CDE was 7.8 ± 7.1 joules, and the 1-month mean percentage of ECL was 15% ± 14% in the diabetic group. Mean CDE was 6.6 ± 3.8 joules, and the 1-month mean percentage of ECL was 11% ± 11% in the nondiabetic group. The CDE was not significantly different between both groups. The percent decrease in ECL was statistically higher in the diabetic group than in the nondiabetic group (P = 0.03). The degree of diabetic control, based on hemoglobin A1c greater or less than 7, did not yield a significant difference in CDE or percentage ECL. Diabetic patients demonstrated increased ECL when compared with nondiabetic patients after cataract surgery. However, the role of diabetic control in reducing ECL remains unclear