Punctal Ectropion repair using the Raus-Garito clamp.

PURPOSE: To evaluate the results from the correction of ectropion of the punctum lacrimale in lower eyelids with a new surgical clamp. DESIGN: Prospective study. METHODS: Eighty eight eyelids in 55 patients with mild and moderate ectropion were included in the study. An excision of a diamond of tarso-conjunctiva with retractor reattachment and concomitant correction of horizontal lid laxity, if present, was performed. RESULTS: Resolution of tearing was obtained in 77 eyes. In 11 eyes, persistent tearing was reported. CONCLUSION: Conclusion:Conclusion: Repair of early to intermediate ectropion of the lacrimal punctum using the Raus-Garito clamp is associated with a good functional and cosmetic outcome.

Unilateral Keratoconus after Chronic Eye Rubbing by the Nondominant Hand.

INTRODUCTION: To report the development of unilateral keratoconus in a healthy male after persistent unilateral eye rubbing by the nondominant hand which was not needed for professional activities. METHODS: Observational case report. RESULTS: A 60-year-old male was first seen in our clinic due to decreased vision in his left eye. Slit-lamp biomicroscopy of the left eye revealed Vogt's striae, stromal thinning, and a stromal scar. Corneal topography showed a stage 4 keratoconus. Clinical examination and corneal topography of the right eye were normal. Medical history revealed a habit of chronic eye rubbing only in the left eye because of the right hand being occupied for professional needs. During follow-up of 5 years, Scheimpflug images of the right eye stayed normal while the left eye showed a stable cone. DISCUSSION: This case report supports the hypothesis of mechanical fatigue of the cornea due to repetitive shear stress on the surface caused by eye-rubbing.

[Developments in corneal transplants: lamellar techniques emerging]. / Ontwikkelingen in corneatransplantatie: lamellaire technieken in opkomst.

Corneal transplants are the most frequently performed human transplant procedure. In the last decade, we have seen large developments in the field of corneal transplant surgery. Currently, several techniques are being used in the Netherlands, each with its own advantages and disadvantages and with distinct indications. In penetrating keratoplasty all layers of the cornea are replaced by a donor cornea. In so-called lamellar corneal transplantation only the affected layer of the cornea is replaced by donor tissue. The developments in corneal transplantation surgery have resulted in an improved prognosis in terms of vision and fewer complications.

Changes in Forward and Backward Light Scatter in Keratoconus Resulting From Corneal Cross-Linking.

PURPOSE: To study the forward and backward light scatter in keratoconic corneas before and after cross-linking. DESIGN: An institutional, prospective, cross-sectional study was conducted. METHODS: This study includes 35 eyes of 25 patients with keratoconus scheduled for either standard corneal collagen cross-linking with riboflavin (CXL) or transepithelial corneal cross-linking (TE-CXL). A group of 26 healthy myopic eyes from 26 prerefractive patients was included as normal reference. Before and 6 months after cross-linking, forward light scatter was measured using the compensation comparison method, whereas backward light scatter was measured using Scheimpflug imaging. RESULTS: In keratoconic eyes, backward light scatter originating from the corneal stroma was [mean (SD)] 27.2% (8.2%) higher than in the normal eyes (P < 0.001). In the anterior stroma, this increased backscatter was significantly correlated with the maximum corneal curvature Kmax as a measure of keratoconus severity (Pearson ρ = 0.582, P = 0.003). For forward light scatter, no significant difference was seen between the normal and keratoconus groups, nor was there any correlation with keratoconus severity. After CXL, the backscatter increased significantly by [mean (SD)] 33.0% (9.5%) in the entire corneal stroma (P = 0.001), whereas for TE-CXL, no significant increase was seen. Forward scatter increased significantly by [mean (SD)] 0.10 (0.10) log units (P = 0.009) and 0.09 (0.10) log units (P = 0.003) for CXL and TE-CXL, respectively, which is near the detection limit for an average patient. CONCLUSIONS: Unlike TE-CXL, CXL increases the already-elevated stromal backscatter in keratoconus. Forward scatter increases equally for both techniques.