Clinical Outcomes of Surgical Techniques in Congenital Cataracts

PURPOSE: To investigate the general clinical features of congenital cataracts and to determine their relationship to visual prognosis and surgical complications according to age at operation and surgical procedure adopted. METHOD: We retrospectively evaluated 92 eyes in 61 patients with congenital cataracts who underwent cataract surgery between January 1996 and December 2006. The demographic data, surgical technique, post-operative complications, and final visual prognosis were evaluated. RESULTS: The average age at surgery was 3.17 years (range 1 month to 11 years), and the mean follow-up was 40.02 months (range 6 to 46 months). Of the 56 eyes that could be checked for visual acuity after cataract extraction, 29 (51.7%) had a BCVA of > or =0.5 at last visit. Unilateral congenital cataracts (p=0.025) and congenital cataracts with strabismus (p=0.019) showed significantly poorer visual outcomes. Patients with nystagmus also experienced a poor visual outcome; 6 patients (67%) had a BCVA of <0.1. Posterior cataracts had the worst visual prognosis (p=0.004). No statistically significant differences in posterior capsular opacity (p=0.901) or synechia formation (p=0.449) were observed between surgical techniques, but children younger than one year showed a higher tendency for PCO and synechia formation. CONCLUSIONS: Anterior vitrectomy did not reduce postoperative complications. Higher rates of complications (PCO, posterior synechia) developed in children younger than one year of age.

Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty for Keratoconus

PURPOSE: To compare the therapeutic outcomes after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) in patients with keratoconus. METHODS: We retrospectively reviewed the clinical records of 57 patients diagnosed with keratoconus who had undergone DALK (19 eyes of 19 patients) and PKP (38 eyes of 38 patients) in Samsung medical center between January 1995 and January 2006. RESULTS: The 19 and 38 patients with keratoconus who underwent DALK and PKP had mean ages of 25.3 (range: 17-46) and 26.2 (range: 12-51) years, respectively. These groups were followed up for mean times of 16.7 (range: 6-34) and 45.7 (range: 6-115) months after surgery, respectively. The DALK group showed significantly higher values of refractive power, central corneal thickness, and endothelial cell density, while two eyes (10.5%) in the DALK group developed stromal rejection, which resolved after steroid therapy. In the PKP group, eight eyes (21%) developed endothelial rejection, among whom one eye (2.6%) resulted in a graft failure of a patient who underwent re-PKP, and two eyes (5.3%) in the PKP group developed secondary glaucoma. CONCLUSIONS: DALK should be considered as the primary surgical technique in keratoconus, because the visual outcome is comparable with PKP and it reduces severe complications such as secondary glaucoma and the risk of graft failure by preserving the corneal endothelium compared to PKP.

Two Cases of Presumed Graft Rejection after Deep Anterior Lamellar Keratoplasty

PURPOSE: To report two cases of presumed immune-mediated stromal rejection developed after deep anterior lamellar keratoplasty (DALK). METHODS: A 32-year-old woman and a 14-year-old man underwent DALK for keratectasia after LASIK surgery and keratoconus, respectively. Both patients developed stromal edema and peripheral corneal vascularization along the suture tract after the surgery. Under the impression of corneal stromal rejection, subconjunctival, oral, and topical steroid therapy were performed. RESULTS: In both cases, vision improved, and complete reversal of stromal edema and regression of peripheral vascularization were attained. CONCLUSIONS: Immune-mediated stromal rejection can occur after DALK surgery, which can be treated effectively by steroid therapy.

A Case of Solitary Bone Plasmacytoma Presenting with Erythematous Swelling of the Upper Eyelid

PURPOSE: To demonstrate a rare case of orbital solitary bone plasmacytoma that presented with erythematous swelling of the upper eyelid. METHODS: A 64-year-old woman presented with a erythematous swelling of the right upper eyelid that persisted for 8 months prior to examination. There were 3 mm of proptosis in the right eye on ophthalmologic examination and an orbital tumor was detected on computed tomography (CT) scan, infiltrating the intracranial space and the sphenoid bone. Therefore, we performed incisional biopsy through the right upper eyelid. RESULTS: Histopathologic examination revealed the tumor to be a plasmacytoma (lambda light chain-type) and all the systemic work-ups (serologic and urinary protein immunoelectrophoresis, bone marrow biopsy, radiologic examination) to rule out multiple myeloma were negative. Because of these factors, a diagnosis of solitary bone plasmacytoma was made. Radiation therapy (5,000 Gy/25 fractions) was performed over 5 weeks and the size of the tumor was found to have markedly decreased on a follow-up CT scan. CONCLUSIONS: Solitary bone plasmacytoma is rare and has variable prognoses. This condition should be considered when the presenting symptom is eyelid swelling and proptosis.