The Short-Term Effect of Topical Cyclosporine A 0.05% in Various Ocular Surface Disorder

PURPOSE: To evaluate the efficacy of topical cyclosporine A 0.05% (Restasis) in the treatment of dry eye symptoms caused by various ocular surface inflammatory disorders. METHODS: Thirty three patients with ocular surface diseases, including 17 with Sjogren syndrome, 8 with meibomian gland dysfunction (MGD), 4 with Thygeson's keratitis, and 4 with atopic keratoconjunctivitis (AKC) were treated with Restasis twice a day for 3 months. During follow up, the symptom severity assessment (burning, itching, foreign body sensation, blurring, photophobia, and pain), TBUT (tear break up time), Schirmer score, frequencies of artificial tear use, onset of symptomatic relief, subjective satisfaction score, and side effects were evaluated. RESULTS: In patients with Sjogren syndrome, foreign body sensation, blurring, photophobia, and pain were reduced after treatment, and the mean Schirmer score, TBUT increased and frequencies of artificial tear use decreased significantly. In patients with MGD, photophobia was reduced after treatment, TBUT and artificial tear use improved after 2 months, and the Schirmer score increased at 3 months. In patient's with Thygeson's keratitis, foreign body sensation and photophobia reduced, and the Schirmer score was increased at 3 months. No significant changes in symptoms, Schirmer score, or TBUT were observed in patients with AKC. Of all subjects, 55% reported symptomatic relief between 3 and 5 weeks after treatment. The mean satisfaction score after treatment was the highest for patients with Sjogren syndrome. Two subjects reported a temporary burning sensation, and one subject quit using Restasis because of bitter taste and a burning sensation. CONCLUSIONS: Treatment with Restasis appeared to be effective in treating dry eye symptoms in patients with Sjogren syndrome. It was shown to be partially helpful in patients with MGD and Thygeson's keratitis, while it showed no beneficial effect in patients with AKC.

Clinical Analysis of Infectious Keratitis after LASIK

PURPOSE: To improve the understanding of infectous keratitis after LASIK by analyzing our clinical experiences. METHODS: We retrospectively reviewed the records of 12 eyes of 9 subjects who developed infectious keratitis after LASIK, and compared them in terms of onset of symptoms, microbiologic profile, medical and surgical interventions, and final visual acuities. RESULTS: Among them, one eye was found to have culture-proven bacterial infection, five eyes with non tuberculous mycobacterial infection, one eye with Nocardial infection, one eye with fungal keratitis and four eyes of two subjects with unisolated microorganisms. Bacterial infections included unisolated cases presenting 2 days after LASIK, mycobacteria presented at an average of 14.4 days after LASIK, Nocardia presented 4 months after LASIK (7 days after trauma), and fungus presented 3 days after LASIK. Bacterial infections were diagnosed immediately after onset of symptoms, and resolved 30 days after treatment. Mycobacterial infections were diagnosed 14 days (6-55 days) after onset and resolved after 6.2 months of treatment, which included flap amputation in 4 of 5 eyes. Fungal infections were diagnosed 30 days after onset, and resolved after 2.5 months of treatment. Norcardial infections were diagnosed 17 days after onset, and resolved after 3 months. Final visual acuities were over 0.5 in 4 of 5 cases of bacteria, in 3 of 5 cases of mycobacteria, in the 1 case of Nocardia and light perception in fungal keratitis. CONCLUSIONS: Bacterial infections tended to present within two days, whereas mycobacteria presented about 14 days after LASIK. Mycobacterial infections required the longest duration of treatment, however the visual outcome was the worst in fungal keratitis.

Clinical Analysis of Infectious Keratitis after LASIK

PURPOSE: To improve the understanding of infectous keratitis after LASIK by analyzing our clinical experiences. METHODS: We retrospectively reviewed the records of 12 eyes of 9 subjects who developed infectious keratitis after LASIK, and compared them in terms of onset of symptoms, microbiologic profile, medical and surgical interventions, and final visual acuities. RESULTS: Among them, one eye was found to have culture-proven bacterial infection, five eyes with non tuberculous mycobacterial infection, one eye with Nocardial infection, one eye with fungal keratitis and four eyes of two subjects with unisolated microorganisms. Bacterial infections included unisolated cases presenting 2 days after LASIK, mycobacteria presented at an average of 14.4 days after LASIK, Nocardia presented 4 months after LASIK (7 days after trauma), and fungus presented 3 days after LASIK. Bacterial infections were diagnosed immediately after onset of symptoms, and resolved 30 days after treatment. Mycobacterial infections were diagnosed 14 days (6-55 days) after onset and resolved after 6.2 months of treatment, which included flap amputation in 4 of 5 eyes. Fungal infections were diagnosed 30 days after onset, and resolved after 2.5 months of treatment. Norcardial infections were diagnosed 17 days after onset, and resolved after 3 months. Final visual acuities were over 0.5 in 4 of 5 cases of bacteria, in 3 of 5 cases of mycobacteria, in the 1 case of Nocardia and light perception in fungal keratitis. CONCLUSIONS: Bacterial infections tended to present within two days, whereas mycobacteria presented about 14 days after LASIK. Mycobacterial infections required the longest duration of treatment, however the visual outcome was the worst in fungal keratitis.

Treatment of Epithelial Ingrowth after Laser in Situ Keratomilusis Using Amniotic Membrane Patch

PURPOSE: To present the result of a new technique for compressing the flap with amniotic membrane patch to manage epithelial ingrowth following a lacerated or microperforated flap near the visual axis during laser in situ keratomileusis (LASIK) surgery. METHODS: Four patients having epithelial ingrowth involving the visual axis were treated as follows: Under a surgical microscope, 3~5 landmark sutures were located at the margin of the flap and the flap was lifted carefully. After removing epithelial cells, preplaced corneal sutures were tied to fix the flap and a prepared amniotic membrane patch was tightly sutured to the sclera to compress the entire cornea. The amniotic membrane overlay was maintained for about a week and then removed. RESULTS: All four eyes achieved a best corrected visual acuity of 20/25 or better and no eyes have shown signs of recurrence within 3 months. CONCLUSIONS: Amniotic membrane patch can be a useful way to secure the flap in the treatment of epithelial ingrowth threatening the visual axis, especially when direct sutures are deemed difficult.

Treatment of Epithelial Ingrowth after Laser in Situ Keratomilusis Using Amniotic Membrane Patch

PURPOSE: To present the result of a new technique for compressing the flap with amniotic membrane patch to manage epithelial ingrowth following a lacerated or microperforated flap near the visual axis during laser in situ keratomileusis (LASIK) surgery. METHODS: Four patients having epithelial ingrowth involving the visual axis were treated as follows: Under a surgical microscope, 3~5 landmark sutures were located at the margin of the flap and the flap was lifted carefully. After removing epithelial cells, preplaced corneal sutures were tied to fix the flap and a prepared amniotic membrane patch was tightly sutured to the sclera to compress the entire cornea. The amniotic membrane overlay was maintained for about a week and then removed. RESULTS: All four eyes achieved a best corrected visual acuity of 20/25 or better and no eyes have shown signs of recurrence within 3 months. CONCLUSIONS: Amniotic membrane patch can be a useful way to secure the flap in the treatment of epithelial ingrowth threatening the visual axis, especially when direct sutures are deemed difficult.