ABSTRACT
In this retrospective case series, we examine the outcomes of diffractive trifocal intraocular lens implantation after cataract surgery, in patients with subclinical and forme fruste keratoconus. Eight eyes of four patients (aged between 47 and 64) were included in the study and underwent phacoemulsification with implantation of AT LISA tri 839MP or AT LISA tri-toric 939MP intraocular lenses (Carl Zeiss Meditec AG, Jena, Germany). Post-operative evaluation included a visual acuity test at three distances (6m, 80cm, and 40cm), a visual acuity test at three low contrast levels (25%, 12.5%, and 6%), and a questionnaire about the patients' experience with photic phenomena and overall satisfaction with the achieved quality of vision. Our results show that spectacle freedom was achieved in all cases with a high satisfaction rate among participants. We hope our results would encourage surgeons to offer this technology to carefully selected candidates with stable subclinical and forme fruste keratoconus undergoing cataract surgery, giving them the possibility of achieving spectacle independence.
ABSTRACT
PURPOSE: To report a case of Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap, with severe acute ocular manifestations successfully managed with sutureless Amniotic Membrane device ProKera® (Bio-Tissue, Inc., Miami, FL) and topical steroids, followed by late complications that were successfully managed with intravenous immunoglobulin (IVIG) therapy. OBSERVATIONS: A 24-year-old lady, known case of epilepsy, admitted to the burn unit with SJS-TEN overlap attributed to a recent change of her anti-convulsant therapy, with severe ocular manifestations, inability to open both eyes, and poor visual acuity. Early management included intensive topical steroids and lubrication, in addition to the application of a ProKera® device. Despite achieving full epithelialization within two weeks with the improvement of ocular manifestations, the patient presented three weeks later with recurrence of conjunctival epithelial defects, partial ankyloblepharon, and severely dry corneas. These late sequelae were managed with bandage contact lens (BCL) application, intensive topical steroid, and lubrication in addition to IVIG therapy. After six cycles of IVIG therapy, ocular manifestations improved significantly and the patient achieved uncorrected visual acuity of 6/9 in both eyes. Conclusion and importance: Existing evidence suggests that the use of IVIG in combination with systemic steroids in the early phase of SJS-TEN can reduce mortality, without affecting the final visual outcome in patients with ocular manifestations. This case highlights the possible role of IVIG therapy alone - without systemic steroids - in managing and preventing long-term ocular complications of SJS-TEN.
ABSTRACT
Alport syndrome is a genetic disorder that manifests as renal disease, hearing loss and ocular dysfunction. Lenticonus is one such ocular condition, in which the lens takes on an abnormal cone shape, with a protrusion either at the front or back of the lens. Both sides of the lens are rarely affected at the same time in the general patient population. Although anterior lenticonus is the type that is often reported in Alport syndrome, it is rare for such patients to have both anterior and posterior lenticonus. Here, the case of a 32-year-old male with Alport syndrome is described. The patient was diagnosed with a progressive posterior lenticonus, having been diagnosed eight years earlier with isolated anterior lenticonus. Examination of the eye revealed the typical indications of lenticonus with flecked retinopathy. The patient had co-presenting astigmatism and a refractive error, which could not be corrected by wearing contact lenses or spectacles. It is critical that such cases are anticipated and identified prior to performing surgery, so that an appropriate approach can be taken, thereby minimizing surgical complications.
