Grooved and nongrooved clear corneal incisions in phacoemulsification: permeability study.

PURPOSE: To detect the inflow of trypan blue through grooved and nongrooved sutureless self-sealing clear corneal incisions at the end of phacoemulsification as compared to a control group. METHODS: A prospective randomized masked trial considered 52 eyes randomized into 3 groups in which phacoemulsification was performed: group A, nongrooved incisions; group B, grooved incisions; and group C, controls. By the end of each surgery, trypan blue was instilled on the ocular surface in groups A and B and rinsed out after 2 minutes. A sample of the anterior chamber content was collected and analyzed by high-performance liquid chromatography to identify and quantify the trypan blue concentration. The presence of trypan blue was expressed as a specific single peak graphic image. The mean areas of these peaks were used to assess the groups using a nonparametric Mann-Whitney test. RESULTS: There was a statistically significant difference between the nongrooved incisions group and the control group (p = 0.0448). No significant difference was observed between group B (grooved incision) and controls (p = 0.1800). CONCLUSIONS: Trypan blue was detected in the anterior chamber when nongrooved clear corneal incision was used. There was no trypan blue detection in the group with grooved clear corneal main incisions.

Excimer laser phototherapeutic keratectomy for keratoconus nodules.

PURPOSE: To report the outcomes of contact lens-intolerant patients with keratoconus (KCN) with subepithelial nodules treated with excimer laser phototherapeutic keratectomy (PTK). METHODS: The charts of all contact lens-intolerant patients with KCN who underwent excimer laser PTK for subepithelial nodules were identified using a computer database and were retrospectively reviewed. Preoperative and postoperative visual acuity and method of correction, surgical treatment, epithelial healing, complications, and KCN nodule recurrence were all analyzed. RESULTS: Fifteen eyes of 15 patients with a minimum follow-up of 3 months were reviewed. Mean follow-up time was 23.1 months (SD +/- 42.5 months, range 3-143 months). In 9 eyes, the epithelial defect healed by postoperative day 3 and all eyes healed by postoperative day 6. There was no infection or corneal melting in any of the eyes. After PTK, 11 patients were refit successfully with rigid gas-permeable contact lenses and 4 wore glasses. Three patients had a recurrence of the KCN nodule at 3, 8, and 23 months postoperatively. One of them had a repeat PTK 23 months after the initial surgery, improving to 20/40 with contact lenses at 55 months postoperatively. Another patient decided to have a penetrating keratoplasty, and the third patient is considering repeat PTK or penetrating keratoplasty. CONCLUSION: PTK effectively removed KCN nodules without recurrences in most patients and can be a successful modality to improve contact lens tolerance and delay or avoid more invasive surgery.