ABSTRACT
Keratoglobus is a controversial issue and still remains as one of the ambiguous corneal disorders; it can be managed by different surgical techniques successfully; yet the risk of globe rupture is high in these patients due to corneal weakness. In cases of progressive involvement, a large corneal graft is needed due to extreme thinness of the cornea. Recent adventures in surgical techniques have led to the introduction of new managements particularly in Keratoglobus treatment such as the "tuck procedure" in which a 12 mm corneo-scleral graft is miniaturized at its peripheral margin. A pocket is formed at the limbus of the recipient and the donor graft is "tucked" into it. We present a case of epikeratoplasty in Keratoglobus management. A 45-year-old man with no history of a systemic disease underwent epikeratoplasty with the diagnosis of advanced bilateral keratoglobus since three years and six months before in the left and right eye, respectively. Pachymetry and best-corrected visual acuity [BCVA] were recorded before and six months after surgery. The highest recorded BCVA was 5/200 before the operation, whereas it was measured 6/10 [left eye] and 4/10 [right eye] at six-month follow-up examinations. Pachymetric findings improved from 244 to 773 and 212 to 744 [thinnest points] in the left and right eyes, respectively. Epikeratoplasty is a relatively safe, effective and reversible extraoccular procedure in the management of keratoglobus. It can also be performed to flatten the cornea and protect it against acute corneal hydrops and perforation.
Subject(s)
Humans , Male , Corneal Diseases/surgery , Visual AcuityABSTRACT
Foodborne botulism is a serious condition caused by Clostridium botulinum neurotoxin. Clinically, botulism presents as bilateral cranial nerve neuropathy and descending paralysis. We report a unique presentation of botulism to remind clinicians of this potentially fatal condition. In this observational case report initial evaluation showed only esodeviation. This progressed to unilateral cranial nerve six [CN VI] paresis along with systemic signs. Clinical diagnosis was made based on in-depth history and concurrent symptoms in three other patients. Foodborne botulism presenting as diplopia and unilateral motility deficits is rare and can represent a diagnostic and therapeutic challenge to the ophthalmologist
ABSTRACT
A retrospective, nonrandomized, single-center clinical study was designed to evaluate the outcomes of corneal collagen crosslinking [CXL] for progressive keratoconus in Iranian patients 12 months after CXL. This study was carried out at Navid Didegan Eye Center, a private clinic, Mashhad, Iran. Ninety-two eyes of 53 subjects with progressive keratoconus were evaluated in this study. All eyes completed 1-year follow-up. The outcome measures were uncorrected visual acuity [UCVA], best spectacle-corrected visual acuity [BSCVA], sphere and cylinder refraction, keratometry, and corneal thickness. Comparison of baseline and 1-year postoperative data is reported in this study. The Wilcoxon signed-ranked and Student's t-tests were used for statistical analyses. P < 0.05 was statistically significant. The mean age was 21.5 +/- 3.4 years [range, 16 -30 years]. Thirty-one [58.5%] of the subjects were men and 22 [41.5%] were women. Mean baseline UCVA and BSCVA were 0.61 +/- 0.31 and 0.06 +/- 0.12 logarithm of minimal angle of resolution [logMAR], respectively. One year postoperatively UCVA was 0.31 +/- 0.25 logMAR and BSCVA was 0.0 +/- 0.01 logMAR. UCVA and BSCVA were statistically higher postoperatively [P < 0.001, both parameters]. The mean astigmatism decreased by 0.78 +/- 1.49 diopter [D] with significant variation during the follow-up period [P < 0.001]. Mean baseline simulated keratometry [SIM K] was 46.94 +/- 2.37 D and decreased to 46.0 +/- 2.33 D on year postoperatively [P < 0.001]. Corneal CXL seems to be efficient in stabilization of progressive keratoconus progression in Iranian patients at 1 year of follow up