Comparison of refractive changes after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus.

PURPOSE: To compare refractive changes occurring after deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) in patients with keratoconus. METHODS: We retrospectively reviewed the medical records of 57 patients with keratoconus who received DALK (19 eyes of 19 patients) or PKP (38 eyes of 38 patients) before and after surgery between January 1996 and January 2008, in an effort to evaluate the surgical results and clinical courses. The principal outcome measures were as follows: preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, and corneal topography including anterior chamber depth (ACD). RESULTS: We noted no significant difference between the DALK and PKP groups in terms of postoperative UCVA, BCVA, astigmatism, or donor-recipient graft size disparities. For the PKP and DALK groups, the mean postoperative spheres were -1.64 D and -4.29 D at 6 months (P = 0.01) and -2.73 D and -4.22 D at 12 months, respectively (P = 0.04). Postoperative mean central corneal powers (3.0/5.0 mm zone) were 45.01/45.03 D and 46.94/47.84 D, respectively (P = 0.04 and P = 0.02). ACD after surgery was 3.25 and 3.37 mm at the final follow-up, respectively (P = 0.02). CONCLUSIONS: Although DALK is a safe alternative in cases of keratoconus, the DALK group evidenced significantly higher myopia than did the PKP group, which was related to steeper central corneal power and deeper ACD.

Postoperative astigmatism and axis stability after implantation of the STAAR Toric Implantable Collamer Lens.

PURPOSE: To evaluate the efficacy, safety, and rotational and footplate stability of the STAAR Toric Implantable Collamer Lens (TICL; STAAR Surgical Co) for correction of myopic astigmatism. METHODS: In this prospective, consecutive, interventional case series, a TICL was implanted uneventfully in 30 consecutive eyes of 20 patients with myopia and astigmatism. The uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, and astigmatism were measured preoperatively and at last follow-up. To evaluate postoperative axis deviation from the intended axis and footplate displacement, a digital anterior segment photograph was taken after full mydriasis and ultrasound biomicroscopy for the four footplates of the TICL in each eye at last follow-up. Possible risk factors for TICL rotation were analyzed through correlation analysis. RESULTS: After mean follow-up of 7.6 months, the mean refractive astigmatism decreased from 2.43 +/- 1.24 diopters (D) preoperatively to 0.73 +/- 0.47 D postoperatively, and the mean difference between intended and achieved TICL axes was 4.03 +/- 3.39 degrees. The absolute value of TICL rotation had significant correlation with the spherical power of the TICL (P = .037). The footplates of all TICLs were in situ in the ciliary sulcus except for one case in which one of the four footplates was located below the ciliary sulcus. CONCLUSIONS: Implantation of the STAAR TICL appears to be an effective and safe method for correction of myopic astigmatism. No clinically significant rotation or footplate displacement of the TICLs was detected postoperatively during mean follow-up of 7.6 months.

Changes in iridocorneal angle structure and trabecular pigmentation with STAAR implantable collamer lens during 2 years.

PURPOSE: To evaluate the changes in iridocorneal angle structure and trabecular pigmentation after implantation with the STAAR Implantable Collamer Lens (ICL), as potential risk factors of secondary glaucoma. METHODS: An ICL was implanted in 48 eyes of 29 patients with high myopia. Angle opening distance (distance between trabecular meshwork and iris) measured at 500 microm from the scleral spur and trabecular-iris angle were assessed preoperatively and at 1, 6, 12, and 24 months postoperatively by ultrasound biomicroscopy, and trabecular pigmentation was evaluated preoperatively and at 1, 12, and 24 months postoperatively by standardized gonioscopic photography. RESULTS: Mean follow-up was 33.2 +/- 7.3 months. One-month postoperative trabecular-iris angle and angle opening distance values were significantly smaller than preoperative values by 41.5% and 31.8%, respectively (P < .001), but no significant progressive changes were observed thereafter. The mean trabecular pigmentation of four quadrants did not change significantly during the first month after ICL implantation (P = .317), but significantly decreased at 1 and 2 years postoperatively compared with the preoperative value (P = .039 and .047, respectively). Intraocular pressure (IOP) remained stable in all eyes throughout follow-up except in one eye, which showed elevated IOP and significantly increased trabecular pigmentation requiring antiglaucoma medications. CONCLUSIONS: No ongoing narrowing of iridocorneal angle was noted after approximately 40% narrowing at 1 month postoperatively. There was no general increase in trabecular pigmentation or IOP over a mean follow-up of 33.2 months. Considering significant initial angle crowding and one eye with increased trabecular pigmentation and IOP, careful monitoring of iridocorneal angle and IOP is required during the early postoperative period, especially for 1 month.

Ultrasonic biomicroscopic evaluation of cyclodialysis before and after direct cyclopexy.

OBJECTIVES: To investigate the clinical manifestations and surgical prognoses after direct cyclopexy in patients with traumatic cyclodialysis according to the cleft extent as determined by ultrasound biomicroscopy (UBM). METHODS: A detailed ophthalmologic examination, which included gonioscopy and UBM, was performed before and after direct cyclopexy in 32 eyes of 31 patients with traumatic cyclodialysis clefts. RESULTS: Cyclodialysis clefts were accurately diagnosed and delineated in all 32 eyes using UBM. Cyclodialysis resulted in hypotony with a mean intraocular pressure of 3.2 mm Hg irrespective of cleft size. On A-scan ultrasonography, mean (SD) preoperative and postoperative lens thicknesses were 4.4 (0.4) mm (range, 3.71-4.92 mm) and 4.1 (0.4) mm (range, 3.42-4.57 mm), respectively, and mean (SD) preoperative and postoperative axial lengths were 23.2 (0.7) mm (range, 21.91-24.57 mm) and 23.6 (0.7) mm (range, 22.47-24.56 mm), respectively. The larger a cleft was, the longer it took for a postoperatively elevated intraocular pressure to normalize after direct cyclopexy. Postoperative visual acuities were significantly better than preoperative values, even when direct cyclopexy was performed 54 months after trauma. CONCLUSIONS: Even small clefts usually resulted in hypotony and visual prognosis was better after cyclopexy, even in cases with a protracted history. Larger clefts need longer postoperative follow-up to check for intraocular pressure normalization after direct cyclopexy.

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.

Pichia anomala fungal keratitis.

PURPOSE: To report a case of fungal keratitis of the eye caused by Pichia anomala in a patient with systemic lupus erythematous and Stevens-Johnson syndrome. METHODS: This was a retrospective chart review. RESULTS: A 50-year-old woman with systemic lupus erythematosus presented with ocular pain of 4-day duration. Culture of corneal scrapings was positive for P. anomala. Clinically, the organism appeared to respond to topical natamycin, amphotericine B, and oral itraconazole. CONCLUSIONS: A rare case of P. anomala-associated keratitis was successfully treated with topical amphotericin B, natamycin, and systemic inidazole.