Modified surgical epikeratoplasty for keratoglobus: anatomic and visual findings

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.

simple way to clear the media for vitrectomy in eyes with corneal edema

Herein we introduce a simple approach for clearing an edematous cornea during vitreoretinal surgery in eyes with decompensated corneal endothelium, allowing the surgeon to postpone penetrating keratoplasty. This technique was performed in 3 eyes by filling the anterior chambers with air or silicone oil, and sufficiently cleared the media for completion of vitrectomy. This simple technique enables completion of the vitrectomy without a temporary keratoprosthesis and penetrating keratoplasty in eyes with corneal edema due to endothelial decompensation

Alteration of tear film after vitrectomy and its influencing factors

To detect the prevalence of dry eye after vitrectomy and its influencing factors. Schirmer I, Tear Basic Secretion Test and Tear Breakup Time was done preoperatively and 3 months postoperatively on consecutive patients undergoing vitrectomy in Khatam Hospital from 2005 to 2006. Eyes with previous peritomies of more than 120° and symptoms of dry eye or tear tests compatible with a diagnosis of dry eye were excluded. Intraoperative factors including the extent of peritomy, extent of inadvertent conjunctival lacerations, extent of scleral depression and the instrument used for scleral depression were recorded. Scleral depression was graded extensive if it was done for more than 180° of globe circumference. Seventy five eyes of 75 patients were studied. Forty six [61.3%] of patients were male. The mean age of the patients was 47.13 +/- 18.85 years. Peritomy size was on average 179.33 +/- 124.75 and the mean size of conjunctival ruptures was 2.18 +/- 4.33 mm. Based on the type of instrument used for scleral depression, patients were divided into 4 groups: 1] metallic instrument, 6 cases [8%] 2] cotton applicator 32 cases [42.7%] 3] both, 14 cases [18.8%] 4] none [no scieral depression], 23 cases [30.7%]. Of 52 cases with scleral depression, the depression was extensive in 35 cases [46.7% of all eyes]. Thirteen eyes [17.3%] developed tear film parameters or symptoms consistent with dry eye. All of these eyes had undergone extensive scleral depression. Cotton applicator had been used significantly more in cases which developed dry eye. There was a direct relation between extent of peritomy and inadvertent conjunctival laceration and development of dry eye. Due to damage to the conjunctiva during operation, vitrectomy is apt to cause dry eye. To lower the risk of this complication, scleral depression, peritomy and possibility of inadvertent conjunctival lacerations should be minimized. It is also better to use metallic instruments for scleral depression rather than cotton applicator