Combined corneal collagen cross-linking and posterior chamber toric implantable collamer lens implantation for keratoconus.

A 29-year-old woman with keratoconus underwent posterior chamber toric implantable Collamer lens (Visian ICL; STAAR Surgical, Monrovia, CA) implantation 12 months after corneal collagen cross-linking with riboflavin and ultraviolet radiation-A. No intraoperative or postoperative complications were observed. Three months postoperatively, uncorrected distance visual acuity improved from counting fingers to 20/40 and corrected distance visual acuity improved from 20/100 to 20/30. Combined cross-linking treatment and posterior chamber toric phakic Collamer lens implantation in a two-step procedure seems to be an effective method for correcting keratoconus in patients with high myopia and astigmatism. Despite the encouraging results, longer follow-up is necessary to evaluate the outcomes of this approach

Descemet stripping automated endothelial keratoplasty in a child after failed penetrating keratoplasty.

Use of Descemet stripping automated endothelial keratoplasty (DSAEK) has been reported in children for the treatment of postoperative endothelial decompensation and Descemet membrane break after forceps delivery. Rapid visual recovery and minimally induced postoperative astigmatism make DSAEK preferable to penetrating keratoplasty for the management of isolated endothelial disorders in this age group. We present a case of DSAEK in a 4-year-old boy for the management of irreversible endothelial rejection after penetrating keratoplasty. Three months after the procedure, the cornea remained clear with the donor button in place

Topography-based keratoconus progression after corneal collagen crosslinking.

The aim of this study was to report 2 cases with topographic keratoconus progression despite stability for a long-term period after corneal collagen crosslinking (CXL). This is a case report. Two patients with progressive keratoconus underwent CXL treatment. Four and 5 years postoperatively, a topographic examination revealed an increase in the keratometric values indicating keratoconus progression. Post-CXL, topographic keratoconus progression may occur several years after, despite stability for a long-term period

Management of pellucid marginal corneal degeneration with simultaneous customized photorefractive keratectomy and collagen crosslinking.

A 34-year-old woman had simultaneous photorefractive keratectomy and corneal collagen crosslinking with riboflavin-ultraviolet-A irradiation for the treatment of progressive pellucid marginal corneal degeneration in both eyes. No intraoperative or early postoperative complications occurred. Twelve months postoperatively, the uncorrected visual acuity was assessed at 20/40 in both eyes compared with counting fingers preoperatively. The corrected visual acuity also improved from 20/50 and 20/63 to 20/25 and 20/32 in the right eye and left eye, respectively. Corneal topography revealed a significant improvement in both eyes. Despite the encouraging results, longer follow-up is necessary to confirm the stability of the results

New directions for continuing education

Publ. comme no 26, june 1985 de la revue New directions for continuing educationBibliogr. à la fin des textesIndex: p. 107-11

Photorefractive keratectomy followed by same-day corneal collagen crosslinking after intrastromal corneal ring segment implantation for pellucid marginal degeneration.

A 28-year-old man with progressive pellucid marginal degeneration (PMD) had photorefractive keratectomy (PRK) followed by same-day corneal collagen crosslinking (CXL) for progressive PMD 12 months after intrastromal corneal ring segment implantation (Intacs). No intraoperative or early postoperative complications occurred. Nine months postoperatively, the uncorrected distance visual acuity improved from finger counting to 20/63 and the corrected distance visual acuity improved from 20/40 to 20/25. Corneal topography revealed a significant improvement in keratometry (from 46.73/38.67 to 44.92/39.01), which remained stable during the 9-month follow-up period. Despite the encouraging results, longer follow-up is necessary to evaluate the outcomes of this approach

Interface Haze Formation After Ultra Thin Flap Laser in Situ Keratomileusis.

In this case series, five patients (10 eyes) underwent laser in siter keratomileusis (LASIK) for the correction of moderate myopia and astigmatism with the Schwind Carriazo Pendular microkeratome 90 mum head. Flap (superior hinged) thickness measured intraoperatively was assessed less than 70 mum in all eyes. On first month's postoperative examination, subepithelial mild corneal haze with consequent myopic regression was found in all patients. A significant improvement of haze formation and residual refractive error were observed during the following postoperative months. In conclusion, post-LASIK subepithelial corneal haze after thin flap creation is a temporarily potential complication that could affect patient's refractive error during the first postoperative month

INTACS followed by KeraRing intrastromal corneal ring segment implantation for keratoconus.

To describe the visual and refractive outcomes in three eyes (two keratoconic patients) with previous intrastromal corneal ring segments (INTACS, Addition Technology Inc) that underwent adjuvant single KeraRing (Mediphacos) intrastromal corneal ring segment implantation. Two keratoconic patients (three eyes) with implanted INTACS segments underwent an additional (without explanting previous INTACS) single KeraRing segment implantation. No intraoperative complications occurred. Six months postoperatively, uncorrected distance visual acuity improved from 20/100 and 20/200 to 20/32 and 20/40 in the right and left eyes, respectively, of patient 1, and from 20/400 to 20/50 in the treated right eye of patient 2. Corrected distance visual acuity improved from 20/50 and 20/100 to 20/30 and 20/32 in the right and left eyes, respectively, of patient 1 and from 20/200 to 20/40 in patient 2. Keratometric measurements improved from 51.00/45.70 to 47.00/44.60 diopters (D) and from 50.80/48.80 to 42.70/40.30 D in the right and left eyes, respectively, of patient 1, and from 49.30/45.70 to 45.60/44.10 D in patient 2. In keratoconic patients with INTACS in place, adjuvant single intrastromal corneal ring segment (KeraRing) implantation could improve visual and refractive outcome

LASIK flap buttonhole treated immediately by PRK with mitomycin C.

To describe the visual outcomes of three patients who had LASIK flap buttonhole and were treated immediately with photorefractive keratectomy (PRK) and topical mitomycin C (MMC) 0.02%. Three patients underwent bilateral LASIK with the SCHWIND Carriazo-Pendula 90 microm head microkeratome. In all three cases, a buttonhole flap occurred in the left eye. The flap was repositioned and phototherapeutic keratectomy for 50 microm was used for epithelial removal while immediate PRK with MMC was performed to treat the buttonhole flap. Three months after the procedure, uncorrected distance visual acuity and corrected distance visual acuity were 20/20 with regular topographic findings. Using PRK with MCC immediately after the occurrence of the LASIK flap buttonhole may be an effective treatment

Management of post laser in situ keratomileusis ectasia with simultaneous topography guided photorefractive keratectomy and collagen cross-linking.

A thirty-nine year old man was referred to our institute due to progressive decreased visual acuity five years after bilateral Laser in situ Keratomileusis (LASIK). Topography revealed signs of post - LASIK ectasia. Patients' left eye was treated with simultaneous Topography Guided Photorefractive Keratectomy (PRK) followed by Corneal Collagen Cross Linking (CXL). Twelve months after the combined procedure both uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) showed significant improvement while topographic findings revealed an improvement of the astigmatic pattern. All higher order aberrations showed a significant decrease twelve months postoperatively. Combined topography guided PRK and corneal cross linking could represent an alternative treatment for post - LASIK ectasia