Salzmann's-like nodular degeneration following laser in situ keratomileusis.

We report the development of bilateral Salzmann's-like corneal lesions located at the site of laser in situ keratomileusis (LASIK) flap margins in 2 patients. These lesions resulted in ocular surface irritation as well as induction of irregular astigmatism and associated loss of best corrected visual acuity. Both patients had bilateral LASIK before the occurrence of the corneal lesions. A biopsy was performed on 1 nodule. The epithelium overlying this raised bluish-white corneal lesion appeared irregular in thickness, with replacement of Bowman's layer by periodic acid-Schiff positive thickened basement membrane-like material. Underlying this basement membrane was a layer of relatively regular, hypocellular, collagenlike connective tissue, which demonstrated hyalinization on trichrome staining. Based on these 2 cases, it seems possible that the hyposecretion of tears, decreased blink rate, and Dellen effect that often occur following LASIK could produce the corneal irritation needed to induce Salzmann's nodular degeneration.

A viral model for corneal scarring and neovascularization following ocular infection of rabbits with a herpes simplex virus type 1 (HSV-1) mutant.

PURPOSE: Herpes simplex virus type 1 (HSV-1) remains a major cause of corneal scarring and visual loss. Although efforts have been made, no reproducible animal model is available to examine recurrent corneal disease. Here we propose a rabbit ocular model to study recurrent corneal disease using an HSV-1 mutant that reactivates with high efficiency. METHODS: Rabbits were ocularly infected with 2 x 10 PFU/eye of the parental McKrae, dLAT2903 (a LAT-null virus with a low-reactivation phenotype), or CJLAT (a high-reactivation virus). Acute ocular disease [days 2, 4, 7, and 10 postinfection (pi)], recurrent ocular disease, and neovascularization (days 30 to 58 pi) were monitored. RESULTS: All acute ocular disease symptoms, including conjunctivitis and corneal disease, were similar with all 3 viruses. No corneal scarring was detected in any eyes up to day 30 pi. Between days 35 and 58 pi, corneal scarring was observed in 11/14 (experiment 1) and 18/22 (experiment 2) eyes of CJLAT-infected rabbits. Significantly less corneal scarring was seen in eyes of rabbits infected with McKrae (0/18 and 0/16) or dLAT2903 (0/16 and 3/24) (P < 0.0001). Many of the eyes with corneal scarring developed obvious, measurable neovascularization. CONCLUSIONS: Rabbits infected with CJLAT developed corneal scarring and neovascularization similar to that of clinical ocular HSV-1 recurrent disease. Because this occurred well after the acute infection had resolved, the corneal scarring and neovascularization appeared to be recurrent disease. Thus, CJLAT ocular infection of rabbits may provide a good and reproducible animal model to study factors involved in corneal scarring and neovascularization from recurrent ocular HSV-1.

Laser in situ keratomileusis in patients with posterior polymorphous dystrophy.

PURPOSE: To report short-term results of LASIK in 4 eyes with the vesicular form of posterior polymorphous dystrophy (PPMD). METHOD: A review was performed of 2 patients with PPMD who underwent bilateral LASIK. Patients were asymptomatic at the time of presentation and had no prior ocular history. Preoperative measurements were made of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal pachymetry, and endothelial cell density (ECD). All 4 eyes underwent uneventful LASIK. Postoperative measurements of UCVA and BSCVA were performed at follow-up visits 1 day, 1 month, 3 months, and 1 year after surgery, along with pachymetry and ECD measurements at the 3-month and 1-year visits. Results were analyzed. RESULTS: At 1 year, all eyes had an UCVA equal to or better than 20/25 and BSCVA equal to or better than 20/20. There was a small mean endothelial cell loss (2.3%) at 1 year. No adverse events were experienced. CONCLUSIONS: Short-term results indicate efficacy and safety of LASIK on eyes with posterior polymorphous dystrophy. Further study is needed to assess long-term outcomes in a larger study population.

Mechanical stability of microkeratome-assisted intracorneal keratoprosthesis implantation.

OBJECTIVE: To develop a laboratory model to study intracorneal keratoprosthesis implantation. METHODS: A combination microkeratome and artificial anterior chamber system was used to create a hinged lamellar keratectomy on 13 human corneas. After reflecting the flap, the posterior stroma was trephined at either 2.5 or 3.0 mm. A model keratoprosthesis was positioned in the bed. The flap was sutured closed. Intrachamber pressure was increased, and wound leak pressure was recorded. The anterior corneal lamella was trephined at either 3.0 or 3.5 mm to expose the keratoprosthesis. Leak pressure was again determined. RESULTS: After keratoprosthesis placement and prior to anterior trephination, all 13 corneas were watertight at maximum attainable intrachamber pressures. With posterior/anterior trephination combinations of 2.5/3.0 mm, 2.5/3.5 mm, or 3.0/3.5 mm, mean +/- SD wound leak pressure occurred at 95 +/- 12 mm Hg, 32 +/- 7 mm Hg, or 59 +/- 12 mm Hg, respectively (P<.01). CONCLUSIONS: With a posterior trephination of 2.5 mm, there is significant keratoprosthesis-cornea interface destabilization between a 3.0- and 3.5-mm anterior trephination. For an anterior trephination of 3.5 mm, interface destabilization improves by increasing the posterior trephination to 3.0 mm. CLINICAL RELEVANCE: An intracorneal keratoprosthesis may be implanted using microkeratome assistance. Our laboratory model provides a useful method for examining a range of posterior and anterior trephination diameters and their effects on the mechanical stability of intracorneal keratoprosthesis placement.

Implantation of an Artisan phakic intraocular lens for the correction of high myopia after penetrating keratoplasty.

We report 2 cases in which an Artisan phakic intraocular lens (IOL) (Ophtec) was used to successfully treat high myopia after penetrating keratoplasty (PKP). The first case was a 43-year-old man who had a manifest refraction of -13.75 +3.00 x 50 with a best corrected visual acuity (BCVA) of 20/40(-2) after PKP in the left eye. Approximately 9 months after implantation of the Artisan IOL, the manifest refraction was -2.00 +2.50 x 60 with a BCVA of 20/30(+2). The second case was a 31-year-old man who had a manifest refraction of -10.75 +2.25 x 122 and a BCVA of 20/40 after corneal transplantation in the right eye. Ten months after implantation of the Artisan IOL, the manifest refraction was -2.75 +4.75 x 80 with a BCVA of 20/40. Endothelial cell density did not change significantly in either patient after surgery. The Artisan phakic IOL may provide an alternative method to correct high myopia after PKP.