Globe rupture with aphakia, aniridia, secondary glaucoma and late corneal decompensation: A multi-staged approach to management

Severe blunt ocular trauma may result in immediate and delayed complications requiring appropriate management algorithms. We hereby report a case of globe rupture, aphakia, traumatic aniridia, and secondary glaucoma in a 33-year-old male following road traffic accident. He was treated initially by primary repair followed by novel combined approach of aniridia IOL with Ahmed glaucoma valve implantation. Delayed corneal decompensation required deferred penetrating keratoplasty. After a follow-up of 3.5 years after last surgery, patient maintains good functional vision with stable IOL, clear corneal graft and controlled intraocular pressure. A meticulously planned and staged management approach appears better suited in complex ocular trauma in such scenarios giving a good structural and functional outcome

Clinical and surgical outcomes of glaucoma drainage device tube in ciliary sulcus versus anterior chamber in North Indian glaucoma patients

Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.

A novel side effect of mitogen-activated protein kinase inhibitor cobimetinib: Acute corneal decompensation

A 38-year-old man with a diagnosis of BRAF-mutated metastatic melanoma was referred to our clinic. He had been under treatment with 60-mg oral cobimetinib daily for 21 days/7 day off in combination with 960 mg vemurafenib twice daily. The patient had symptoms of blurred vision and photophobia in his right eye. A slit-lamp examination revealed bilateral central corneal stromal opacity and epithelial microcystic edema Involvement was more severe in the right eye compared with the left eye. Fourteen days after the first visit, the patient's symptoms and slit-lamp findings were largely resolved. We suggest that endothelium pump failure was involved in this acute corneal decompensation case similar to the mechanism in retinal pigment epithelium.

Indicaciones y técnicas de trasplante de córnea en una clínica oftalmológica privada en Colombia / Indications and techniques of corneal transplantation in a private ophthalmologic clinic in Colombia

Introducción: el trasplante de córnea es el injerto mas frecuente en el campo de la medicina; las técnicas para realizarlo han evolucionado permitiendo hacer procedimientos menos invasivos, con menor riesgo de rechazo del injerto y con una recuperación más rápida. La escasez de donantes para realizar trasplantes de córnea, genera una limitación terapéutica muy importante en el campo de la patología corneal. Objetivo: Reportar las Indicaciones y Técnicas empleadas en los Trasplantes de Córnea, en una institución privada con atención terciaria en Oftalmología en Bogotá, Colombia. Diseño del Estudio: Estudio transversal de fuentes secundarias. Método: Se hizo un estudio transversal, con las historias clínicas electrónicas de los pacientes operados con algún tipo de trasplante de córnea, en la Clínica Barraquer de América en el periodo comprendido desde Enero del 2010 a Diciembre del 2018 Resultados: Las cuatro primeras Indicaciones para Trasplantes de córnea fueron: 1) Ectasias Corneales 38.27% 2) Descompensación corneal 20.88% 3) Reposición de Injerto 17.72% 4) Leucomas Cicatriciales 16.22%. Las técnicas empleadas fueron Injerto Penetrante el 54.11% - Injertos Laminares (43.52%) con un 17.25% de Injertos Endoteliales. Conclusión: Existen diferencias en la frecuencia de las Indicaciones para trasplante de córnea según la región del país y también respecto a las publicaciones internacionales. El Queratocono fue la indicación mas frecuente. La Queratoplastia Penetrante la técnica más frecuente como procedimiento primario, pero también como técnica alternativa debido a la falta de oportunidad para realizar el trasplante.

Background: corneal transplant is the most frequent graft in the fi eld of medicine; the techniques to carry it out have evolved allowing to make less invasive procedures, with less risk of rejection of the graft and with a faster recovery. The shortage of donors to perform corneal transplants generates a very important therapeutic limitation in the field of corneal pathology.. Objective: To report the Indications and surgical techniques in Corneal Transplants in a tertiary referral center and private Ophthalmological clinic in Bogotá-ColombiaStudy Design: Cross sectional study using secondary data. Method: A cross sectional study was performed with the electronic clinical records of the patients that had a corneal graft of any kind during the period between January 2010 and December 2018 at the Barraquer Clinic in América. Results: The top four indications for corneal transplantation were: 1) Corneal Ectasias 38.27% - 2) Bullous Keratopathy 20.88% ­ 3) Re-Graft 17.72% and 4) Leucomas 16.22%. Penetrating Keratoplasty was the most common indication (54.11%) followed by Lamellar Techniques 43.52% of which Endothelial keratoplasty was performed in 17.25%. Conclusion: Corneal transplant indications and its frequency, are different between country regions in Colombia and towards international reviews. For us, Keratoconus was the most frequent indication. and Penetrating Keratoplasty, the most frequent technique as a primary procedure, but also as an alternative technique due to the lack of opportunity to perform the transplant.

Non-Descemet stripping automated endothelial keratoplasty for post radial keratotomy corneal edema

An elderly male with monocular status presented with complaints of gradual loss of vision in his left eye. Slit-lamp evaluation revealed postradial keratotomy (RK) corneal decompensation. He underwent non-Descemet stripping automated endothelial keratoplasty (nDSAEK) in his left eye. Postoperatively, his visual acuity improved from counting finger at 1 m to 20/200, J5. Graft adherence was good. A preexisting epiretinal membrane with macular edema was noted, but our patient refused any further surgical intervention for the same. In conclusion, nDSAEK may be considered as an effective treatment modality for the management of post-RK corneal decompensation.

Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes

Purpose: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. Methods: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. Results: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA <20/40) with medical therapy and required surgery; of which three required a combined penetrating keratoplasty with cataract surgery, while one required isolated cataract surgery and one underwent penetrating keratoplasty. Glaucoma was present in 3/5 eyes undergoing surgery, one of which required a trabeculectomy. Five of the six eyes who had a good clinical outcome with medical therapy alone had been treated with concomitant oral steroids, along with topical antibiotic-steroid combination therapy. Conclusion: Oral corticosteroid supplementation to the topical steroid antibiotic treatment in patients with corneal bee sting injury where corneal involvement and anterior reaction is severe at presentation or inflammation not ameliorating with topical steroids alone prevents serious vision-threatening complications such as corneal decompensation, cataract, and glaucoma.

Combined endothelial keratoplasty and clear lens extraction for corneal decompensation in irido-corneal endothelial syndrome.

A 38-year-old woman presented with corneal decompensation in left eye secondary to irido-corneal endothelial (ICE) syndrome. She underwent simultaneous Descemet’s stripping endothelial keratoplasty (DSEK) and clear lens extraction with posterior chamber intraocular lens implantation. The surgery was accomplished comfortably without rupture of peripheral anterior synechiae (PAS). 5 weeks postoperatively, the graft was a􀄴 ached, the cornea was clear and best-corrected visual acuity improved from 20/400 to 20/30. DSEK combined with clear lens extraction appears to be an eff ective measure to treat corneal decompensation in patients with ICE syndrome. Associated lens extraction in such cases increases the working space in anterior chamber for DSEK, which minimizes the intra-operative graft manipulation. This also avoids a future diffi cult cataract surgery in the presence of PAS and an endothelial graft, which may increase the chances of graft survival.

Long-Term Results after Cataract Surgery in Patients with Low Corneal Endothelial Cell Density

PURPOSE: To investigate the long-term results after cataract surgery in eyes with low endothelial cell density (ECD). METHODS: A retrospective medical record review was performed of 19 patients with low ECD (lower than 1000 cells/mm2) who 31 patients with a normal ECD (higher than 1600 cells/mm2) underwent cataract surgery. Clinical parameters including visual acuity, intraocular pressure (IOP), spherical equivalent refraction, anterior chamber depth, axial length and central corneal thickness (CCT) were measured and specular microscopy was performed to analyze the ECD and its morphology. The follow-up periods were 1 week, and 1, 3, 6 and 12 months postoperatively. RESULTS: Clinical parameters except ECD and CCT had no significant difference between the 2 groups until 12 months postoperatively. The decreasing rate of ECD and increase of CCT were significantly different between the 2 groups at 1 week and 1 month postoperatively. However, no significant difference was found after 3 months postoperatively. Only 1 eye in the low ECD group with 367 cells/mm2 developed bullous keratopathy. CONCLUSIONS: In the low ECD group, a significant decrease of ECD and increase of CCT were observed at 1 month after cataract surgery. However there were no significant differences compared with the control group after 3 months postoperatively. The results suggest that cataract surgery is safe postoperatively for a long-term for a patient with low ECD.