Wound instability and management after cataract surgery in a patient with prior laser in situ keratomileusis.

We report a case of cataract wound instability and subsequent management after cataract surgery in a patient who had had hyperopic laser in situ keratomileusis (LASIK). Standard cataract surgery was performed through a nasal limbal incision. One day postoperatively, the uncorrected visual acuity (UCVA) was 20/20 and the wound was stable. Subsequent examinations revealed overlying corneal edema, cataract wound slippage with corresponding with-the-rule astigmatism, and decreased vision. Separating and resuturing the cataract wound resulted in significant and stable improvement in the UCVA to 20/40. At 18 months, the best corrected visual acuity was 20/20 with a refraction of -3.50 +0.25x155 and keratometry of 44.75/45.00@155. Understanding wound stability and its management in cataract surgery in patients with prior LASIK refractive surgery will become increasingly important as more of these patients present.

Analysis and documentation of progression of Fuchs corneal dystrophy with retroillumination photography.

PURPOSE: Fuchs corneal dystrophy (FCD) is a degenerative disorder of the cornea that is characterized by the progressive accumulation of guttae, which are small excrescences of Descemet's membrane. We describe a method for documenting the location and number of guttae, and ask whether disease progression can be observed during relatively short periods. METHODS: Patients with FCD were imaged by standard retroillumination photography with a slit lamp. Scanned photographs were analyzed by using NIH ImageJ software to determine the number of individual guttae and areas of confluence. RESULTS: In 4 FCD patients, photographs taken 23 to 30 months apart revealed that, once formed, individual guttae and their relative positions persisted during this period. Very few guttae disappeared, and the emergence of many new guttae was observed. Determination of the area with confluent guttae was used to quantify disease stage. CONCLUSIONS: Computer-assisted analysis of retroillumination photographs is proposed as an effective way to document the number and distribution of individual guttae. Although the disease typically progresses slowly during decades, we have been able to detect the formation of new guttae within only 2 years. This rapid assessment of disease progression could be used to measure phenotypic differences between genetic subtypes of FCD. It also could provide important baseline information and methodology for clinical trials of therapeutic options, should these become available.

Bilateral corneal anesthesia associated with diaphragmatic paralysis, ovarian failure, and developmental delay.

PURPOSE: To describe two siblings with bilateral corneal anesthesia associated with multiple systemic abnormalities. DESIGN: Interventional case report. METHODS: A 38-year-old Hispanic woman was seen for bilateral corneal ulcers, exposure keratitis, hemorrhagic retinopathy, and multiple systemic abnormalities. A younger sibling with similar but milder findings was also examined. Medical and genetic evaluation was investigated in these two siblings with bilateral decreased sensation and multiple abnormalities from a consanguineous union. RESULTS: Examination of the patient showed bilateral corneal anesthesia, and multiple systemic abnormalities included diaphragmatic paralysis, ovarian failure, multiple thrombotic cerebrovascular accidents, pedal edema, mandibular hypoplasia, and developmental delay. Milder findings were seen in a sibling. Corneal ulcers were stabilized after treatment that included bandage contact lens, pressure patching, topical antibiotics, and tarsorrhaphy. CONCLUSIONS: The combination of corneal anesthesia and systemic abnormalities, with parental consanguinity, suggests an inherited syndrome.