Peripheral hypertrophic subepithelial corneal degeneration: clinical aspects related to in vivo confocal microscopy and optical coherence tomography.

To report the findings of anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM) in two patients with peripheral hypertrophic subepithelial corneal degeneration (PHSD). Case series by restrospective chart review and imaging analysis of AS-OCT and IVCM. Slit lamp examination of the two patients revealed a bilateral subepithelial-elevated fibrous tissue of the superior-nasal quadrant, as well as inferior-nasal in one of the patients. Best corrected visual acuity ranged from 20/25 to 20/15. AS-OCT showed continuous, homogenous, well-demarked hyperreflective subepithelial band associated with hyperreflectivity in the anterior stroma. IVCM demonstrated normal epithelial cell morphology and arrangement and a fibrous structure subepithelial and in the anterior stroma. AS-OCT and IVCM can facilitate the diagnosis of PHSD and differentiate it from other corneal entities that present peripheral opacifications

Isolated descemetorhexis for anterior synechiolysis prior to endothelial keratoplasty - case report and technique.

To describe the utilization of descemetorhexis for reformation of the anterior chamber in eyes with central iridocorneal synechiae before endothelial keratoplasty (EK). A 71-year-old man with a history of trabeculectomy complicated by hypotony presented with bullous keratopathy in the presence of extensive iridocorneal synechiae and a flat anterior chamber. In order to proceed with EK, synechiolysis with the use of viscoelastic and scissors was attempted. Despite successful dissection of the peripheral strands, the pupillary margin of the iris remained attached to the endothelium. Therefore, descemetorhexis was performed to detach the Descemet membrane along with central synechiae and create sufficient space for safe EK at a later stage. Corneal clarity was restored by ultrathin Descemet stripping automated endothelial keratoplasty, leaving a fibrous membrane in the pupillary plane, which was excised 2 months later, allowing an improvement of best-corrected visual acuity to 0.5. Isolated descemetorhexis was successfully employed to reform the anterior chamber and proceed with EK in a case of bullous keratopathy and resistant iridocorneal synechiae. This stepwise approach may be considered in similar cases in order to avoid a more invasive treatment, ie, penetrating keratoplasty and synechiolysis

Resolution of Corneal Fibrosis After Descemet's Stripping Automated Endothelial Keratoplasty: A Case Report.

To report the resolution of anterior corneal fibrosis after Descemet's stripping automated endothelial keratoplasty (DSAEK), in a patient with chronic corneal edema and anterior stromal scarring. A 63-year-old woman, with a history of Fuchs endothelial dystrophy, presented with increasing discomfort and gradual visual loss in her right eye. Clinical examination revealed long-standing bullous keratopathy accompanied by marked subepithelial fibrosis (SEF). Based on the low postoperative visual potential due to glaucomatous optic neuropathy, we decided to proceed with DSAEK. During the follow-up period, SEF was found to gradually resolve. Corneal clarity was restored and an improvement in visual acuity was observed up to 12 months after surgery. DSAEK alone may represent an effective therapeutic option for the restoration of impaired corneal clarity in patients with long-standing corneal edema and concomitant anterior subepithelial scarring

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

5-year efficacy of all surface laser ablation with cross-linking (ASLA-XTRA) for the treatment of myopia.

The purpose of our study is to examine the long (5-year) efficacy of the all surface laser ablation (ASLA) combined with accelerated cross-linking (CXL) for the treatment of myopia without the use of mitomycin-C (MMC). This retrospective study consisted of 202 eyes of 118 myopic (SD: 2.41, range: - 1.50 to - 12.75 D) patients (44 males, 74 females). Mean age was 28.50 years (SD: 6.45, range: 18 to 51 years) that underwent ASLA with accelerated CXL for the treatment of their myopia. The patients underwent routine postoperative assessment on the 1st, 3rd, 7th day and in the 1st, 3rd, 6th and 12th month, 30th month (±6 months), 4th and 5th year. The mean spherical equivalent (SEq) refractive error changed from - 6.41 ± 2.41 D preoperatively to - 0.02 ± 0.53 D at 5 years postoperatively. The haze score was 0.18, 0.25 and 0.28 at 1, 3 and 6 months postoperatively. At 12 months after the treatment, no eyes had significant corneal haze and in all the following postoperative time intervals the haze traces were gone. ASLA combined with accelerated CXL (ASLA-XTRA) appears to be safe, efficacious and offering very good refractive results. The potential additional benefits of this modality are the stabilizing effect of the refraction and its sterilization effect on the treated cornea without the potential side effects of MMC

Intraoperative anterior optical coherence tomography-guided synechiolysis in a post-penetrating keratoplasty patient with peripheral corneal opacification.

The aim of this study was to describe intraoperative optical coherence tomography (OCT) as an adjunctive device for peripheral synechiolysis in a post-penetrating keratoplasty patient. A 75-year-old female patient presented for follow-up 9 months after a penetrating keratoplasty in the left eye. She presented with anterior peripheral synechiae involving the graft for three clock hours. Peripheral native cornea appeared totally opaque. Synechiolysis was planned, and intraoperative OCT allowed us to detect nonclinically visible synechiae and to confirm complete synechiolysis immediately after surgery. No postoperative complication was recorded. Two months after surgery, the graft was clear and anterior segment OCT did not reveal any residual synechiae or recurrence. Intraoperative OCT is useful to overcome the difficulties in visualization through clinically opaque corneas, as it gives real-time feedback upon the anatomy, the extension of the remaining lesions, and the success of the surgery

Corneal Neovascularization with Associated Lipid Keratopathy in a Patient with Obstructive Sleep Apnea-Hypopnea Syndrome Using a Continuous Positive Airway Pressure Machine.

To report a case of corneal neovascularization with secondary lipid keratopathy in a patient treated with continuous positive airway pressure (CPAP) for obstructive sleep apnea-hypopnea syndrome (OSAHS). A 49-year-old male had been diagnosed with obstructive sleep apnea syndrome 10 years ago and has been treated with the application of a CPAP machine during night sleep ever since. For the past year, the patient had been complaining for ocular irritation and excessive tearing of the left eye on awakening. Slit-lamp biomicroscopy revealed the presence of neovascularization and lipid exudation in the inferior third of the cornea of the left eye. Ocular patching during night sleep resulted in recession of the reported symptoms and shrinkage of the neovascularization, while the area of lipid exudation ceased to enlarge. To the best of our knowledge, this is the first report of corneal neovascularization in a patient using a CPAP machine for OSAHS

Transepithelial Phototherapeutic Keratectomy Using a 213-nm Solid-State Laser System Followed by Corneal Collagen Cross-Linking with Riboflavin and UVA Irradiation

Purpose. To present a case of a keratoconic patient who underwent epithelial removal with transepithelial phototherapeutic keratectomy (t-PTK) using a 213-nm solid-state laser system followed by corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) irradiation. Methods. Case report. Results. A twenty-four-year-old male with keratoconus underwent CXL treatment after epithelial removal with t-PTK using a solid-state laser system. No intra- or early postoperative complications were found. One month postoperatively, uncorrected visual acuity (UCVA) improved from 20/63 to 20/32 while best spectacle- corrected visual acuity (BSCVA) improved from 20/40 to 20/25. Corneal topography revealed a significant improvement which remained stable during the six-month followup period. Conclusions. Epithelial removal with t-PTK before CXL could improve patient's visual outcome

Corneal melting after collagen cross-linking for keratoconus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Corneal collagen cross-linking is a rather new technique that uses riboflavin and ultraviolet A light for collagen fiber stabilization in keratoconus corneas. Other than reversible side effects, the preliminary results of corneal collagen cross-linking studies suggest that it is a rather safe technique. In this report, we demonstrate a case of corneal melting after corneal collagen cross-linking for keratoconus corneas associated with an acute inflammatory response.</p> <p>Case presentation</p> <p>A 23-year-old Caucasian man with keratoconus cornea stage 1 to 2 underwent uneventful corneal collagen cross-linking treatment according to the Dresden protocol. The next day the patient had intense photophobia, watering and redness of the eye, and his visual acuity was limited to counting fingers. Slit lamp biomicroscopy revealed severe corneal haze accompanied by non-specific endothelial precipitates following an acute inflammatory response. Mild inflammation could be detected in the anterior chamber. Moreover, the re-epithelialization process could barely be detected. His corneal state gradually deteriorated, resulting in descemetocele and finally perforation.</p> <p>Conclusion</p> <p>In this report, we present a case of a patient with corneal melting after standard corneal collagen cross-linking treatment for keratoconus corneas following an acute inflammatory response. Despite modifying postoperative treatment, elaboration of all apparent associated causes by the treating physicians and undergoing extensive laboratory testing, the patient developed descemetocele, which led to perforation. Our report suggests that further research is necessary regarding the safety of corneal collagen cross-linking in keratoconus corneas.</p