RESUMEN
The comorbidity of keratoconus with Fuchs� endothelial dystrophy with cataract is a rare clinical combination. We present an amalgamation of surgical techniques to manage the above clinical conditions and its complications in single setting. The modified triple procedure, namely, the phacoemulsification, pinhole pupilloplasty, and pre-Descemet抯 endothelial keratoplasty (PDEK) in the order of description is followed in single sitting. Lens removal by phacoemulsification, correction of irregular astigmatism by pinhole pupilloplasty (pinhole optics), and exchanging the endothelial layer for PDEK forms the main segments of the triple procedure. This combination of techniques may decrease the risk of multiple surgeries and its related complications. Moreover, it will allow the patient for faster visual rehabilitation by improving the uncorrected visual acuity and visual quality.
RESUMEN
In our report, we present the hypersonic vitrectomy (Vitesse, Bausch and Lomb) being employed for anterior vitreous liquefaction and removal in posterior capsular rupture. The capsular tear with nucleus drop during conventional phacoemulsification was managed by vitrectomy using the hypersonic vitrector after posterior-assisted levitation followed by intraocular lens (IOL) implantation. The minimal cortical and epinuclear lens particles in the anterior chamber and vitreous were also liquefied with a stoke length of 30 to 40 ?m and aspirated via the Vitesse vitrectomy system. The same probe performs the vitrectomy and the nucleus removal. The postoperative period was uneventful with clear cornea, normal fundus, and 20/20 best-corrected visual acuity (BCVA). The hypersonic vitrectomy utilizes the ultrasound power of 29.5 kHz and a stoke length of 0 to 60 ?m for liquefaction of the vitreous. It can be a safe alternative for vitrectomy and lens removal in a single setting.
RESUMEN
Purpose: To analyze the morphological outcomes of the posterior corneal opacity or 搒emilunar sign� in noninfectious anterior scleritis using multimodal imaging. Methods: This was a prospective observational case series. Patients with anterior scleritis from January 2018 to January 2019 were included. Clinical and demographic data were collected. Posterior cornea was visualized using the digital slit lamp photography (Elite, mega digital vision), spectral domain optical coherence tomography (MS39), and specular count analyzer (EM?3000). 揝emilunar sign� was defined by the (1) presence of posterior corneal opacity, (2) concave semilunar pattern, (3) absence of blood vessels, and (4) normal anterior cornea. Incidence, clinical characteristics and significance, correlation with Mantoux sensitivity, and role of multimodal valuation were assessed. Results: Overall 76 eyes of 72 patients were recruited with anterior scleritis. Fifteen eyes of 11 patients (15.3%) presented with semilunar sign. The scleritis was both nonnecrotizing (n = 8) and necrotizing (n = 7). The semilunar configuration appeared as isolated (n = 9) and continuous lesion (n = 6). The extent was directly related to the scleral disease extent (P = 0.002). The mean thickness measured 212.5 � 129.3 ?m. The mean central endothelial cell density (ECD) was 2540.8 � 351.7 cells/mm2, which was significantly higher than the involved peripheral cornea (P = 0.05). The mean surface area of the semilunar sign was 7.7 � 5.2 mm2. There was no significant correlation between the opacity thickness and the best?corrected visual acuity (P = 0.895, r = ?0.39), ECD (P = 0.52, r = ?0.188), and Mantoux (P = 0.696, r =? 0.142). Conclusion: Corneal semilunar sign of scleritis affected the peripheral cornea and caused no functional abnormality in early presentation. Multimodal analysis can aid in clinical assessment and severity.
RESUMEN
Purpose: To find the intraocular lens (IOL) power calculation changes before and after isotonic collagen cross?linking (CXL) in keratoconus patients. Methods: Thirty?five eyes of 25 patients who underwent isotonic CXL were included. The cases included conventional CXL (n = 16), accelerated CXL (n = 7), contact lens?assisted CXL (CACXL) (n = 9), accelerated CACXL (n = 3). All underwent ocular biometry (IOL master), corneal topography (Orbscan II), and simulated keratometry (Orbscan II) preoperatively and 1?year post CXL. Change in best?corrected visual acuity (BCVA), axial length (AL), simulated keratometry (Sim K), anterior chamber depth (ACD), and IOL power were analyzed in the overall data and then grouped based on flattening (Group A) and no flattening (Group B) of Sim K value post CXL procedure. Results: For the overall data, there was no significant change in IOL power (P = 0.05) at the end of 1 year, BCVA showed a significant increase (P < 0.01), and Sim K reading showed a statistically significant flattening (P = 0.001); ACD and AL showed insignificant change. In intergroup comparison, there was no statistically significant change in IOL power. However, in Group A, a significant change in BCVA and Sim K values was observed. In both groups (Group A and Group B), IOL power was found to be negatively correlated with AL and Sim K values. Conclusion: Isotonic CXL did not affect IOL power calculation at the end of 1 year. However, significant change in BCVA and sim K reading was noted