Living-related limbal allograft transplantation for bilateral stem cell deficiency in a patient with bilateral chemical burn

INTRODUCTION. The purpose of this paper was to report the long-term outcome of a living-related limbal allograft transplantation followed by penetrating keratoplasty in a patient with severe bilateral stem cell deficiency. MATERIALS AND METHODS. A 50-year-old woman presented with extensive bilateral stem cell deficiency secondary to ocular acid burn on both eyes. Visual acuity was counting fingers at 30 cm on the right eye and counting fingers at 1 m Snellen line on the left. Limbal allograft transplantation on the right eye from a first-degree living-related relative was performed. The recipient was prepared by removing the abnormal corneal epithelium and vascularised pannus of the right eye under general anaesthesia. Two limbal allografts (mean length of 2–3 corresponding anatomic posi­tions on the recipient). Postoperatively, the host received systemic immunosuppression (steroids and cyclosporine). RESULTS. The cornea of the right eye achieved reepithelialisation within two weeks after surgery, followed by re­duction in vascularity in eight weeks time. After one year of regular follow up, the corneal surface remained stable whereas the stroma was opaque and the vision was low. Therefore, the patient underwent penetrating keratoplasty on the same eye. After the surgery the corneal graft was clear and the visual acuity on the right eye improved to 20/50 Snellen line. No graft rejection occurred after a five-year follow-up. CONCLUSION. Living-related limbal allograft transplantation is a good alternative option in cases of total bilateral stem cell deficiency whenever a conjunctival limbal autograft transplantation is not possible

Topography changes and endothelial cell loss after temporal 1.8 mm coaxial microincision cataract surgery (MICS)

INTRODUCTION. The purpose of this paper was to determine surgically-induced changes both in corneal topographic parameters and in endothelial cell loss after coaxial microincision cataract surgery (MICS) through temporal 1.8 mm incision. MATERIALS AND METHODS. Evaluation was performed in forty eyes of thirty patients who underwent cataract sur­gery. Topographic parameters including corneal astigmatism, surface regularity index (SRI), and surface asymmetry index (SAI) were estimated preoperatively and at one week, four weeks, and eight weeks after surgery. A specular microscope was also used for the measurement of the corneal endothelial density (cells/mm2). The surgically-induced astigmatism (SIA) was calculated by means of vector analysis using Alpins’ method. RESULTS. Eight weeks after surgery the final mean value of SIA was 0.42 D and the differences in topographic parameters such as corneal astigmatism, SRI, and SAI were not statistically significant. Also, the decrease in endothelial cell density eight weeks after surgery was 6.02%. CONCLUSIONS. The changes in SIA and topographic parameters after temporal coaxial 1.8 mm MICS are minimal throughout an eight-week follow up period

Broken intraocular lens haptic during cataract surgery

This is a case report describing a planned routine cataract surgery that was complicated intraoperatively by breakage of the trailing haptic of the intraocular lens. The possibility of lens implantation despite the broken haptic is discussed, and the patient’s postoperative course one month after the surgery is described, in this report

KAMRA corneal inlay for the correction of presbyopia

This is a case report of two patients who underwent presbyopia correction with KAMRA corneal inlay (KAMRA; AcuFocus, Irvine, CA) combined with LASIK surgery. The surgical technique is thoroughly explained, as well as the advantages and disadvantages of the procedure. In both patients, near uncorrected visual acuity significantly improved and distance uncorrected visual acuity remained unchanged. There were no changes in the corneal topography after the corneal inlay implantation

Phototherapeutic keratectomy for the treatment of dense subepithelial infiltrates after epidemic keratoconjunctivitis

This is a case report of a patient who developed dense subepithelial corneal infiltrates after epidemic keratoconjunctivitis and was treated with phototherapeutic keratectomy (PTK). The purpose of this case report is to explain the surgical technique and the results of PTK procedure

Evaluating the safety and efficacy of photorefractive keratectomy combined with corneal collagen crosslinking for the treatment of myopia and myopic astigmatism

INTRODUCTION. The purpose of the study was to evaluate the safety and efficacy of photorefractive keratectomy (PRK) combined with corneal collagen crosslinking (CXL) in patients with potential risk of developing postoperative ectasia, who were not good candidates for LASIK. MATERIALS AND METHODS. Twenty eyes were treated with transepithelial PRK combined with CXL. Patients were evaluated preoperatively for best corrected visual acuity (BCVA), refraction, keratometry, topography, and endothelial cell count. All eyes were treated with Amaris 750s Excimer Laser and KXL system for 90 seconds at 30 mW/cm2. RESULTS. Mean BCVA was improved from 0.0075 ± 0.08 logMAR to 0.025 ± 0.05 logMAR postoperatively. Average keratometry reduced from 44.9 ± 1.9 D to 39.8 ± 3.9 D. Mean minimal corneal thickness reduced from 504 ± 16.7 μm to 405 ± 41 μm. None of the cases developed regression, corneal ectasia, or corneal haze. CONCLUSIONS. Photorefractive keratectomy combined with high-fluence corneal collagen crosslinking (PRK XTRA) appears to be a safe and effective treatment for patients who are not good candidates for LASIK

Partial transepithelial topography-guided PRK combined with corneal collagen crosslinking in patients with keratoconus

INTRODUCTION. The aim of this study is to identify the visual outcome and possible complications of partial transepithelial topography-guided PRK combined with collagen crosslinking in patients with keratoconus. MATERIALS AND METHODS. Twenty eyes (20 patients) were treated with partial transepithelial topography-guided PRK combined with collagen crosslinking. Patients were evaluated preoperatively for best spectacle corrected visual acuity (BSCVA), clinical signs of keratoconus via slit lamp examination, and Scheimpflug-generated corneal topography. All eyes were treated with Amaris 750s Excimer Laser and KXL system. RESULTS . Mean BCVA was improved from 20/100 to 20/25, postoperatively. Mean flat K was 46.8 ± 0.14 D preoperatively and was reduced to 45.2 ± 0.7 D postoperatively. Mean steep K was reduced from 50.2 ± 0.10 D to 47 ± 0.6 D. Total corneal astigmatism was 4.5 ± 0.14 D and decreased to 2.5 ± 0.10 D postoperatively. Average thinnest pachymetry was reduced from 465 ± 9.9 μm to 416 ± 11.3 μm. Total RMS (corneal aberrations) was 15.5 ± 7.4μm and was significantly reduced to 5.5 ± 2 μm. CONCLUSIONS. Partial transepithelial topography-guided PRK combined with collagen crosslinking can benefit patients fitting the criteria for such a procedure, by stabilising their cornea as well as improving their BSCVA.