ABSTRACT
To evaluate the anatomical and visual outcomes of Descemet`s stripping with endothelial keratoplasty [DSEK] in patients with bullous keratopathy after cataract surgery. The study was performed on 20 eyes of 20 patients [13 male, 7 female] with bullous keratopathy [pseudophakic=15, aphakic=5]. Donor lenticule was prepared using a micro keratome [n=12] or manual dissection [n=8]. Patients were excluded in case of extensive corneal scarring and/or vascularization. DSEK surgery was performed by removal of recipient endothelium and Descemet`s membrane, and replacement by the donor lenticule. Patients were followed at least for 6 months. Mean age at surgery was 64.6 +/- 6.7 years and mean follow up was 7.3 +/- 2.1 months. At final follow up 15 grafts were clear. Failure was seen in 5 cases. Visual acuity LogMAR was 1.96 +/- 0.38 before and 0.52 +/- 0.09 after the procedure [P<0.0001]. Mean topographic keratometry was 46.0 +/- 2.9 D before surgery which reached 44.4 +/- 1.7 D postoperatively [P=0.219]. Preoperative astigmatism was 2.5 +/- 1.7 D which decreased to 1.1 +/- 2.3 D at final follow up [P=0.229]. Mean pre- and postoperative surface regularity index [SRI] were 1.47 +/- 0.60 and 0.43 +/- 0.17, respectively [P=0.006]. No case of endothelial rejection was observed. DSEK surgery is an effective treatment modality in cases of bullous keratopathy after cataract surgery with acceptable anatomical and visual outcomes
ABSTRACT
Tears have antimicrobial, nourishing, mechanical, and optical properties and contain components such as growth factors, fibronectin and vitamins to support proliferation, migration and differentiation of corneal and conjunctival epithelial cells. Lack of these epitheliotrophic factors, as in dry eye, can result in severe ocular surface disorders such as persistent epithelial defects. Recently, the use of autologous serum in the form of eye drops has been reported as a new treatment for severe ocular surface disorders. Serum eye drops may be produced as an unpreserved blood preparation. They are by nature non-allergenic and their biomechanical and biochemical properties are similar to normal tears. In vitro cell culture experiments showed that corneal epithelial cell morphology and function are better maintained by serum than by pharmaceutical tear substitutes. Clinical cohort studies have reported its successful use for severe dry eyes and persistent epithelial defects. However, the protocols to prepare and use autologous serum eye drops varied considerably between the studies. In addition to different biochemical properties, protocol variations may also influence the epitheliotrophic effect of the product. Before establishing the definitive role of serum eye drops in the management of severe ocular surface diseases in a large randomized controlled trial, this has to be evaluated in more detail. Based upon the literature reviewed here, two preliminary standard operating procedures for the preparation of serum eye drops are proposed
ABSTRACT
To report a case of hypotonous maculopathy after blunt trauma and its treatment. A 34-year-old woman presented with decreased visual acuity in her left eye following blunt trauma. Right eye examination was unremarkable, but visual acuity of left eye was counting fingers. Slit lamp biomicroscopy of the left eye was within normal limits, but on funduscopy, papillomacular chorioretinal wrinkling was present. Intraocular pressure [IOP] of left eye was 4 mmHg. On gonioscopy, a cyclodialysis cleft was seen from 11 to 1 o'clock. Argon laser therapy to cyclodialysis cleft was performed. Two months later, best spectacle corrected visual acuity of left eye was 20/20 and chorioretinal wrinklings disappeared and IOP was 15 mmHg with timolol 0.5% twice daily. Blunt ocular trauma may result in cyclodialysis cleft which can lead to hypotony and maculopathy, consequently. Argon laser photocoagulation to the cyclodialysis cleft might be an effective way to relieve hypotony and improve vision