Long-term outcomes of amniotic membrane transplantation in contact lens-induced pseudomonas keratitis with impending corneal perforation

Purpose: To report the anatomical and visual outcomes of double layered amniotic membrane transplantation (AMT) in eyes with advanced Pseudomonas keratitis leading to Descemetocele formation. Methods: This prospective interventional case series included 6 eyes of 6 female patients with pseudomonas keratitis caused by contact lens-induced infection who underwent double layered AMT. Surgery was performed after the ulcers were found to be poorly responsive to antibiotics, and severe thinning or Descemetocele had developed. All patients underwent a complete examination pre- and postoperatively, as well as anterior segment optical coherence tomography (OCT) and pachymetry or Orbscan after the procedure. Results: Mean follow-up period was 24 months. There was neither frank corneal perforation nor a need for emergent corneal transplantation in any of the eyes. All patients had visual acuity of hand motions before the procedure which improved to 20/50 to 20/30 three months after surgery. No surgical or postoperative complication occurred in this series. Conclusion: Double layered AMT may result in acceptable anatomical outcomes in patients with advanced Pseudomonas keratitis with Descemetocele formation and can eliminate the need for emergent corneal transplantation

Efficacy of wavefront-guided photorefractive keratectomy with iris registration for management of moderate to high astigmatism by advanced personalized treatment nomogram

Purpose: To evaluate the efficacy of photorefractive keratectomy (PRK) using the advanced personalized treatment (APT) nomogram for correction of moderate to high astigmatism. Methods: This prospective interventional case series included 60 consecutive eyes of 30 patients undergoing wavefront-guided PRK (Zyoptix 217 Z100 excimer laser, Bausch & Lomb, Munich, Germany) using the APT nomogram and iris registration for myopic astigmatism. Mitomycin-C was applied intraoperatively in all eyes. Ophthalmic examination was performed preoperatively and 1, 3 and 6 months postoperatively. Results: Preoperatively, mean sphere was -1.68 ± 2.08 diopters (D), mean refractive astigmatism was -3.04 ± 1.05 D and mean spherical equivalent (SE) was -3.12 ± 1.77 D. Six months postoperatively, mean sphere was + 0.60 ± 0.64 D (P < 0.005), mean cylinder was -0.43 ± 0.46 D (P < 0.005) and mean SE was + 0.28 ± 0.48 D (P < 0.005). Hyperopic overcorrection (≥ +1.0 D) occurred in 3 (5%) eyes. Postoperatively, root mean square (RMS) of higher order aberrations (HOAs) was significantly increased (P = 0.041). RMS of spherical aberration (Z [4, 0]) showed no significant change after surgery (P = 0.972). Conclusion: Considering the acceptable residual refractive error, low rate of hyperopic overcorrection, acceptable uncorrected visual acuity, and low risk of postoperative corneal haze, PRK using the APT nomogram with iris registration and mitomycin-C use is a safe and effective modality for treatment of moderate to high astigmatism