[Corneal endothelial cell density and morphology after photorefractive keratectomy with mitomycin C]

To assess the short-term effect of Mitomycin-C [MMC] 0.02% on endothelial cell density and morphology after photorefractive keratectomy [PRK] in patients with moderate myopia. Forty-two eyes of 21 participants with moderate myopia [range, -4.0 to -8.0 D] underwent PRK with MMC 0.02% for 40 seconds. Specular microscopy was performed preoperatively and repeated 6 months after surgery to determine any change in central endothelial cell density [ECD], mean cell area [MCA], and coefficient of variation in cell size [CV]. Mean patient age was 26.2 +/- 6.3. Mean preoperative spherical equivalent refractive error was -5.2 +/- 1.2 D which was reduced to -0.4 +/- 0.5 D postoperatively [P < 0.001]. Mean ECD was reduced insignificantly from 2920 +/- 363 cells/mm2 preoperatively to 2802 +/- 339 cells/mm2 postoperatively [P = 0.59]. Similarly, there was no significant change in MCA [P= 0.76] or CV [P= 0.52] at six months. Intraoperative MMC 0.02% applied for 40 seconds during PRK for moderate myopia did not significantly change central corneal endothelial cell density and morphology after 6 months

[ case of traumatic carotid cavernous fistula]

To describe a complicated case of traumatic carotid-cavernous fistula [CCF] and our management strategy. A 13-year-old patient was referred one month following a car accident and facial trauma with severe proptosis, chemosis and limitation of ocular movement. Presence of murmur and an enlarged superior ophthalmic vein on orbital imaging suggested an arteriovenous fistula. The patient underwent transarterial fistula ballooning which resulted in alleviation of the fistula and improvement of signs and symptoms. Orbital signs and symptoms following trauma may indicate an arteriovenous fistula

[Keratolimbal allograft in total limbal stem cell deficiency]

To investigate the outcomes of keratolimbal allograft [KLAL] for treatment of total limbal stem cell deficiency [LSCD]. Patients with total LSCD and adequate tear production were included. A total of 27 KLAL procedures were performed in 21 eyes of 20 patients with LSCD. Immunosuppression was achived using mycophenolate and cyclosporine. Main outcome measure was improvement in vision; in addition, KLAL survival and post operative complications were studied. Mean follow up period was 22.14 +/- 11.83 months [range 6-39]. Mean visual acuity improved from 2.53 +/- 0.21 to 1.49 +/- 0.77 LogMAR [P<0.0001]. Six KLALs never re-epithelialized and were considered as primary failures. Mean KLAL survival was 14.23 +/- 1.5 months. Graft survival rate was 61.9% at 1 year and 31% at 20 months. Complications included corneal ulcers in 6, glaucoma in 2 and scleral thining in 1 case. Keratolimbal allograft surgery is successful in the short term for visual rehabilitation of patients with total limbal stem cell deficiency

[Stem cell deficiency in patients with chronic and delayed-onset mustard gas keratopathy]

To evaluate stem cell deficiency using impression cytology [IC] in patients with chronic and delayed-onset mustard gas keratopathy [MGK]. A consecutive series of patients with MGK underwent IC Thirty-five eyes of 18 patients [all male] with mustard gas keratopathy were included in this observational case series. Presence of goblet cells on the corneal side of specimens was considered to indicate stem cell deficiency. Corneal involvement was graded as mild, moderate and severe. Relation between IC findings and clinical grading was evaluated. There was limbal stem cell deficiency in at least one quadrant of the cornea in all 35 eyes [100% of cases]. No differences was found between impression cytology findings [positive versus negative for corneal goblet cells] among different quadrants [p= 0.378]. Clinical grading was the same between nasal and temporal quadrants [P=0.266] and between superior and inferior quadrants [P= 0.263]. Combining the superior and inferior quadrants [vertical zone] and also the nasal and temporal quadrants [horizontal zone] together, clinical grading was more severe in horizontal versus vertical zones [p< 0.001]. There was no correlation between stem cell deficiency and clinical corneal severity [p=0.893]. Varying degrees of stem cell deficiency was demonstrated in all patients with chronic or delayed-onset MGK using IC Clinical corneal manifestations are more severe in nasal and temporal quadrants. We found no correlation between stem cell deficiency and clinical manifestations. Other factors such as perilimbal conjunctival ischemia might play a role