Simultaneous and non-simultaneous penetrating keratoplasty and cataract surgery for Fuchs' corneal endothelial dystrophy and cataract

To determine outcome of simultaneous and non-simultaneous penetrating keratoplasty and cataract surgery in eyes with Fuchs' dystrophy and cataract. The medical records of all patients with a histopathologically confirmed diagnosis of Fuchs' dystrophy who underwent penetrating keratoplasty at the University of Iowa Hospitals and Clinics between January 1, 1990 and December 31, 1999 and who had also undergone cataract extraction and intraocular lens implantation prior to December 31, 2001 were retrospectively reviewed. Patients were assigned to group 1 [cataract surgery followed by penetrating keratoplasty], group 2 [simultaneous penetrating keratoplasty and cataract surgery], and group 3 [penetrating keratoplasty followed by cataract surgery]. Two hundred and twelve eyes met the inclusion criteria. Among these, there were 48 cases in which cataract extraction and IOL implantation was performed prior to penetrating keratoplasty [group 1], 154 in which all three procedures were performed simultaneously [group 2], and 10 in which cataract surgery was performed after penetrating keratoplasty [group 3]. There were no statistically significant differences between the 3 groups with respect to the percentage of eyes that obtained a final visual acuity of 20/40 or better or 20/200 or worse. There were also no statistically significant differences between the 3 groups with respect to graft survival. Patients in group 3 were more likely to have refractive IOL predictability to within 2D of emmetropia than those in group 1 [80.0% vs. 56.1%] and those in group 2 [80.0% vs. 48.0%], but these differences were not statistically significant [P = 0.08, 0.09, respectively]. The performance of either simultaneous or non-simultaneous cataract surgery with penetrating keratoplasty in eyes with Fuchs' dystrophy has no significant effect on visual outcome or graft survival. Cataract surgery performed subsequent to penetrating keratoplasty is associated with a better refractive outcome

Acanthamoeba keratitis at the King Khaled Eye Specialist Hospital

Purpose: To quantify the number of cases and clinical course of Acanthamoeba keratitis treated at the King Khaled Eye Specialist Hospital [KKESH] between December 1982 and May 2005, and to review their clinical course and response to medical and surgical therapy. Retrospective review of medical records of all patients with Acanthamoeba keratitis diagnosed by the KKESH Microbiology or Pathology Laboratory since the opening of the hospital. During a period of over 22 years, only six cases of confirmed Acanthamoeba keratitis were diagnosed and treated at KKESH. In two cases the diagnosis was made by cornea1 biopsy, while four cases required examination of a histopathologic specimen obtained at the time of therapeutic keratoplasty to establish the diagnosis. One eye was cured by medical therapy, while five eyes required one [4 eyes] or two [1 eye] therapeutic penetrating keratoplasty [PKP] to achieve a clinical cure. Three eyes achieved good visual acuity [20/40, 20/50, 20/60], one eye achieved fair visual acuity [20/160], and two eyes suffered profound visual loss [hand motions]. The incidence of Acanthamoeba keratitis may be less in Saudi Arabia than that reported in Western countries although the clinical course is similarly complicated, with most cases requiring therapeutic keratoplasty for definitive eradication of the organism

Treatment of paracentral corneal scar-induced astigmatism with manual superficial keratectomy

Superficial, paracentral corned scars may markedly reduce visual acuity by inducing significant central corneal steepening and irregular astigmatism. Two cases are presented which provide topographic correlation of reduction of central corned astigmatism and improvement in visual acuity following manual superficial keratectomy. In both cases, manual superficial keratectomy was preferred to phototherapeutic keratectomy to avoid the risk of iatrogenic induction of a change in the baseline spherical or astigmatic refractive error