Non-topography-guided photorefractive keratectomy combined with accelerated collagen cross linking for treatment of keratoconus / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the visual, refractive and clinical outcomes of non-topography-guided photorefractive keratectomy(PRK)and corneal collagen cross linking(CXL)in eyes with keratoconus.<p>METHODS: Totally 34 cases were evaluated for uncorrected distance visual acuities(UDVA)and corrected distance visual acuities(CDVA), flat and steep keratometry readings, and complications were evaluated at 1mo, 3mo, 6mo and 12mo postoperatively.<p>RESULTS: Thirty-four patients with mean age of 23.3±4.0 years. Statistically significant improvement was shown in UCVA and CDVA, with steadiness of refection for 1y postoperative. <i>T</i>-test showed a significant difference(<i>P</i><0.05)in all means between the preoperative and postoperative values(visual acuity, spherical and cylinder changes), with stability over a 1y follow up. Fourier analysis of postoperative images showed an axis shift perpendicular to the preoperative axis.<p>CONCLUSION: Simultaneous non-topography-guided PRK and CXL is safe and effective surgical alternative for keratoconus, yielding improvement in the UDVA, CDVA, and refractive status. Stabilization was achieved as early as 3mo after surgery, the only advantage of topography-guided over non-topography-guided PRK might be the minimal over correction of sphere and the cylindrical axis shift in some patients as detected by Fourier analysis of postoperative pentacam.

Two different chemoprophylaxis approaches after phacoemulsification surgery in one thousand patients in Iraq / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the effectivity of the combination of intracameral moxifloxacin 0.1% with subconjunctival triamcinolone acetonide 4 mg as prophylaxis of infection and inflammation after phacoemulsification in comparison with topical medication treated group.<p>METHODS: A total one thousand patients with age range from 38 to 70 years old who scheduled for phacoemulsification were divided into 2 groups of no statistically significant differences in age, preoperative intraocular pressure(IOP)and central macular thickness(CMT), <i>P</i>=0.6, 0.9 and 0.8 respectively. The surgeries were done by 2 surgeons each one planned to use one method of prophylaxis at Eye Speciality Private Hospital, Baghdad, Iraq. For the 1^st group of patients(500)a topical moxifloxacin hydrochloride 0.5% and dexamethasone 0.1% eye drops were prescribed four times a day for 1mo postoperatively. For the 2^nd group intracameral(IC)diluted moxifloxacin at 0.1% with subconjunctival(SC)triamcinolone 4 mg in 0.4mL were administered at the conclusion of the surgery. Follow up visits were on the first postoperative day, 1wk, 1mo, and 3mo postoperatively. Anterior chamber(AC)reaction was examined during the 4 visits while IOP was measured during the last 3 and CMT was measured only in the last one.<p>RESULTS: The current clinical trial study compared 2 samples with 2 different prophylaxis methods. No endophthalmitis case reported in both group. By a 2-Sample <i>t</i>-test, the IC-treated group(group 2)had statistically significant lower AC cells at the 1^st day postoperative visit than the other group while there were no statistically significant differences at 1wk, 1 mo and 3mo visits between the 2 groups. There was no statistically significant difference at 3mo visits in IOP and CMT between the two groups. A breakthrough inflammation rate with the topical medication was 9.6% while in the other group(IC treated )was 4.0%. A significant IOP elevation ≥10 mmHg at 1mo in 2.4% within the topical medication group which was higher than the rate in the other group(0.8%).<p>CONCLUSION: In addition to the safety and effectivity of the combination of intracameral moxifloxacin and subconjunctival triamcinolone in preventing infection and inflammation after cataract surgery. The majority(480)of our included patients didn't require any topical postoperative medication that is cost saving for the patient, helped patients who were unable to administer topical medication, and decreased chance of complication related to patient poor adherence to postoperative medication.

Simultaneous complete intracorneal ring implantation with intrapocket collagen cross-linking for treatment of keratoconus

Background: Keratoconus is a progressive non inflammatory bilateral [usually asymmetric] ectatic corneal disease characterized by paraxial stromal thinning ,weakening that lead to corneal surface distortion ,vision loss primarily from irregular astigmatism and myopia and secondly from corneal scar

Objective: To evaluate visual and refractive outcomes after intracorneal continuous ring [ICCR] implantation combined with intrapocket corneal collagen cross linking in patient with keratoconus.Setting: Eye Specialty Private Hospital, Baghdad, Iraq

Patients and Methods: This study assessed the results of implantation of Myoring ICCR combined with CXL in 40 eyes with KC. Outcome measures include UDVA,CDVA[spectacle correction],refraction, complications and side effects. Postoperative follow- up was up to 1 year

Results: The study evaluated 40 eyes of 34 patients with a mean age of 25.75 years. Preoperatively, the pachymetry at thinnest location range from [367-555 micro m] and the mean keratometry [K] readings 50.51 +/- 3.94D. Post operatively ,there was statistically significant improvement in the UDVA,CDVA,K reading ,manifest spherical and cylindrical refractive errors ,and spherical equivalent [p<.05].The mean UDVA improved by 13 lines ,CDVA improved by 3.5 lines and the mean K reading decreased by 7.14 D .No serious intraoperative complications occurred .Side effects includes glare and night vision problems

Conclusion: Treatment of KC with simultaneous ICCR implantation and intrapocket collagen cross linking significantly improved visual and refractive outcomes .the UDVA and CDVA continuously improved during the 1st year postoperatively