Persistent lamellar interface fluid with clear cornea after Descemet stripping automated endothelial keratoplasty.

To describe clinical properties of a patient with persistent interface fluid syndrome and clear graft, 3.5 years after Descemet stripping automated endothelial keratoplasty (DSAEK). Case report. A 69-year-old woman who had DSAEK in 2006 presented with a clear cornea (no corneal edema) and deep diffuse reticular haze in the right eye. Visual acuity was 20/40. Ultrahigh-resolution optical coherence tomography (UHR-OCT) imaging of the right eye demonstrated persistent interface fluid at the donor-recipient junction. The detachment between donor and recipient corneas was 70 μm at the center. There was no connection between the anterior chamber and the donor/recipient interface. Despite the persistent detachment of the donor cornea, the recipient cornea can remain clear in persistent interface fluid syndrome after DSAEK

Comparison of multimetric D index with keratometric, pachymetric, and posterior elevation parameters in diagnosing subclinical keratoconus in fellow eyes of asymmetric keratoconus patients

Purpose To compare the multimetric D index and other keratoconus-screening parameters in patients with clinical keratoconus in 1 eye and subclinical keratoconus in the fellow eye. Setting Medipol University Hospital and Birinci Eye Hospital, Istanbul, Turkey. Design Retrospective case-control study. Methods Patients with clinical keratoconus in 1 eye and subclinical keratoconus in the fellow eye and eyes of normal subjects were evaluated with a rotating Scheimpflug imaging system (Pentacam). Parameters included anterior curve analysis, keratometry (K) values, minimum corneal thickness, pachymetric progression index, Ambrósio relational thickness, posterior elevation, back difference elevation, and D-index values. The receiver operating characteristic (ROC) curves were analyzed to evaluate the area under curve (AUC), sensitivity, and specificity of each parameter. Results Forty-five patients and 67 normal subjects were evaluated. The pachymetric progression indices, posterior elevation, and the D-index measurements were statistically significantly higher whereas corneal thickness and Ambrósio relational thickness measurements were significantly lower in eyes with keratoconus or subclinical keratoconus than in eyes of normal subjects (P <.05). Using the ROC analysis, the AUC values of the mean steep K, minimum corneal thickness, pachymetric progression index minimum, Ambrósio relational thickness maximum, posterior elevation, back difference elevation, and D index to distinguish between subclinical keratoconus from control subjects were 0.52, 0.64, 0.71, 0.72, 0.71, 0.76, and 0.83, respectively. Conclusion The new multimetric D index seems to be better than other single-metric parameters in diagnosing keratoconus and subclinical keratoconus with good specificity. However, the sensitivity levels of all parameters were relatively limited in the diagnosis of subclinical keratoconus. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2015 ASCRS and ESCRS

Single and multiple injections of subconjunctival ranibizumab for early, recurrent pterygium

Volkan Hurmeric,1 Pravin Vaddavalli,1 Anat Galor,1,2 Victor L Perez,1 Janika San Roman,1 Sonia H Yoo11Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA; 2Miami Veterans Affairs Medical Center, Miami, FL, USAPurpose: To assess the effect of single versus multiple subconjunctival ranibizumab injections in patients with an early pterygium recurrence.Setting: Single-center, academic practice.Study population: Nine patients with early pterygium recurrence.Observational procedure: Subconjunctival ranibizumab (0.5 mg/0.05 mL) was administered adjacent to pterygium recurrence. Group 1 (n = 5) received one injection; group 2 (n = 4) received three injections (time points 0, 2, and 4 weeks) with the ability to retreat as needed.Main outcome measures: Effect of ranibizumab on conjunctival hyperemia and corneal neovascular area over a 6-month follow-up period.Results: In the single injection group, a decrease in conjunctival hyperemia was noted in all patients on postinjection day 1. At follow up, hyperemia grade fluctuated, although all patients had less hyperemia than at baseline. In the recurrent injection group, the median number of injections was 8.5 (range 7 to 9) over the 6 months. In spite of the repeated injections, the pattern of conjunctival hyperemia was similar to that of the single injection group. In group 1, corneal neovascularization remained relatively unchanged over the 6-month period in four patients and decreased in one patient by 24%. In group 2, corneal neovascularization increased in one patient by 39%, remained stable in one patient, and decreased in two patients by 34% and 44%.Conclusion: This is the first study to evaluate the role of ranibizumab in the treatment of an early pterygium recurrence and the first to compare multiple versus single injections. Recurrent injections did not appear to be superior to a single injection with regards to conjunctival hyperemia.Keywords: pterygium, recurrence, ranibizumab, conjunctival hyperemia, corneal neovascularizatio

Ocular Injuries From Improvised Explosive Devices

Purpose To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs). Methods Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre. Results In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20-42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury. In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twenty-two (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4-34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (0.05). Conclusion Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome. Eye (2011) 25, 1491-1498; doi:10.1038/eye.2011.212; published online 19 August 201