Hemilimbal deficiency model of corneal neovascularization: Possible invalidity of the limbal barrier concept

To describe a novel model of corneal neovascularization [NV] in mouse cornea where hemilimbal deficiency is induced with or without corneal epithelial debridement. Following hemilimbal excision with or without corneal epithelial removal, mice corneas were examined and photographed prior to and following the onset of corneal NV. Slides were reviewed by visual observation for evidence of corneal NV. Corneas with complete removal of both limbus and epithelium [group I; n=10] all developed extensive corneal NV by post-operative days [POD] 3-10. Corneas with intact epithelium and complete removal of the limbus [group II; n=7] developed corneal NV by POD's 7 [n= 6] or 30 [n= 1]. Corneas where half of the limbus and more than half of the corneal epithelium were removed [group III; n= 9] developed vessels from the side opposite to the limbal injury by POD's 4-7. Corneas where half of the limbus removed and only the adjacent peripheral corneal epithelium were removed did not show any vessels [group IV; n= 9]. Removal of half of the limbus [hemilimbal deficiency] led to corneal NV from the opposite side of the cornea, in which the limbus was intact, raising question about the function of Limbus as a harrier to corneal NV

Management of astigmatism post penetrating keratoplasty

Despite improvements in outcomes of penetrating keratoplasty, postoperative astigmatism remains a challenge. This review describes the various techniques used to minimize postoperative penetrating keratoplasty astigmatism. The advent of descemet stripping endothelial keratoplasty for corneal disorders involving the endothelium has decreased the incidence of postoperative astigmatism. Spectacles, contact lenses, and refractive surgical techniques are used in various situations to manage high postoperative astigmatism and improve functional vision. Refractive surgical procedures discussed in this review include excimer laser photorefractive keratectomy and laser in situ keratomileusis, mechanical and femtosecond laser incisional keratotomy, wedge resection, and intraocular lens implantation

efficacy, predictability, and safety of Epi-Lasik for the correction of myopia

To report the refractive and visual results of epithelial laser in situ keratomileusis [Epi-LASIK] for the treatment of myopia. Retrospective non-comparative consecutive case series. Sixty nine eyes of 40 patients had Epi-LASIK for the treatment of low myopia or myopic astigmatism. All epithelial separations were performed with the Visijet/Gebauer microkeratome. Primary outcome variables included uncorrected visual acuity [UCVA], best spectacle-corrected visual acuity [BSCVA], manifest refraction, epithelization time, pain, haze and complications. Preoperatively, the mean spherical equivalent [SE] was -3.9 diopters [D] +/- 1.6 D [range -.75 to -7.00 D] and the mean LogMAR BSCVA was 0.0131 +/- 0.04l [range -0.10 to 0.12]. On the final visit, the mean SE was -0.27+0.53D [range -2.50 to 0.50D], the mean logMAR UCVA was -0.079 +/- 0.13 [range -0.48 to 0.12] and the mean LogMAR BSCVA was 0.0039 +/- 0.053 [range -0.18 to 0.1]. 95.1% of eyes achieved a vision of 20/40 or better, and 70.5% achieved a vision of 20/25 or better. 73.8% and 95.1% of eyes were within +0.5D and+1.0D, respectively. Complete epithelialization occured in 6.2 +/- 1.4 days [range 3 to 8 days]; 93.4% of eyes had clear corneas or only trace haze at the final postoperative visit; 94.7% of eyes had no or minimal pain. Epi-LASIK is a safe, effective and predictable method for the treatment of low to moderate myopia and myopic astigmatism

Case Report: Femtosecond Laser-Assisted Small Incision Deep Lamellar Endothelial Keratoplasty

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.

Case Report: Femtosecond Laser-Assisted Small Incision Deep Lamellar Endothelial Keratoplasty

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.

Small incision secondary implantation of a posterior chamber foldable intraocular lens with scleral fixated suture technique

This new technique was done to evaluate the safety and efficacy of secondary implantation of a scleral fixation injectable silicone IOL. A 70-year-old man underwent uncomplicated intracapsular cataract extraction OS in 1978. He complained of contact lens intolerance and a scleral fixation IOL was implanted, safety and efficacy regarding UCVA, BCVA and induced astigmatism was observed. The results revealed that the patient had UCVA of 20/100 at one month and 20/50 at six months and there was a mild insignificant change in astigmatism. The study concluded that scleral fixation injectable IOL is a safe and effective measure in treating aphakia

Studies of Laser Subepithelial Keratomileusis (LASEK) using Leghorn Chick Eye

PURPOSE: Using the effect of 20% ethanol on Leghorn chick cornea, a suitable animal model for LASEK(Laser subepithelial keratomileusis) and effect on LASEK were evaluated. METHODS: Twenty Chick corneas were divided into 4 groups (n=5/group) to be exposed to 20% ethanol for 30 sec, 45 sec, 1 minute and 2 minutes respectively and changes were observed. Another 4 groups of Chick cornea, total of 20 (n=5/group) were prepared to perform nothing, PRK after mechanical or 20% ethanol-assisted debridement, or LASEK respectively and corneal changes were observed. RESULTS: Exposure of the corneal epithelium to 20% ethanol for more than 30 seconds allowed reproducible separation of epithelial flaps in Leghorn chick eyes. TUNEL staining of corneas obtained 4 hours after surgery revealed TUNEL-positive cells in the central superficial stroma and more abundantly in the peripheral superficial stroma around the epithelial flap margin and in the epithelial flap itself, particularly in the basal epithelial layer. Transmission electron microscopy showed similar evidence of apoptosis in the epithelium and anterior stroma. CONCLUSIONS: The Leghorn chick eye appears to be a reasonable model for LASEK surgery. Treatment with 20% ethanol for 30 seconds results in reproducible epithelial flap creation in the chick cornea and in relatively low levels of stromal and epithelial cell death after surgery.