Transepithelial Photorefractive Keratectomy-Review.

The type and nature of refractive surgery procedures has greatly increased over the past few decades, allowing for almost all patient populations to be treated to extremely high satisfaction. Conventional photorefractive keratectomy involves the removal of the corneal epithelium through mechanical debridement or dilute alcohol instillation. An improvement to this method utilises laser epithelial removal in a single-step process termed transepithelial photorefractive keratectomy (transPRK). We explore the history of transPRK from its early adoption as a two-step process, identify different transPRK platforms from major manufacturers, and describe the role of transPRK in the refractive surgery armamentarium. This is a narrative review of the literature. This review finds that TransPRK is a safe and effective procedure that works across a variety of patient populations. Though often not seen as a primary treatment option when compared to other corneal-based procedures that offer a faster and more comfortable recovery, there are many scenarios in which these procedures are not possible. These include, but are not limited to, cases of corneal instability, previous refractive surgery, or transplant where higher-order aberrations can impair vision in a manner not amenable to spectacle or contact lens correction. We discuss refinements to the procedure that would help improve outcomes, including optimising patient discomfort after surgery as well as reducing corneal haze and refractive regression.

Clinical outcomes of transepithelial photorefractive keratectomy versus femtosecond laser assisted keratomileusis for correction of high myopia in South Egyptian population.

AIM: To evaluate the safety and efficacy of transepithelial photorefractive keratectomy (t-PRK) with adjuvant mitomycin C (MMC) versus femtosecond laser assisted keratomileusis (Femto-LASIK) in correction of high myopia. METHODS: Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction (SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12mo postoperatively. RESULTS: The preoperative mean SER was -8.86±1.81 and -9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively (P=0.99) which improved to -0.65±0.43 D and -0.69±0.50 D at 12mo follow up. Mean SER remained stable during the 12mo of follow-up, with no statistically significant difference between the two groups (P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze (one reversible haze grade 2, while the other had dense irreversible haze grade 4). CONCLUSION: t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.

Corneal Endothelial Cell Density and Morphology in Healthy Egyptian Eyes.

PURPOSE: To evaluate the corneal endothelial cell density and morphology in normal Egyptian eyes. METHODS: In total, 568 healthy eyes of 568 Egyptian volunteers aged 20 to 85 years were examined using noncontact specular microscopy for the central corneal thickness (CCT), mean endothelial cell density (MCD), coefficient of variation (CV) in cell area, mean cell area (MCA), and hexagonal cell (Hex) percentage. Variables were compared between sexes and between different age groups. RESULTS: The mean CCT, MCD, and MCA were 514.45 ± 43.04 µm, 2647.50 ± 382.62 cells/mm2, and 390.59 ± 149.94 µm2, respectively. MCD and MCA showed no significant differences between men and women (P=0.171 and 0.099, respectively), whereas CV (%) and Hex (%) showed significant differences (P=0.024 and 0.015, respectively). CCT (P=0.007, r = -0.113) and MCD (P < 0.001, r = -0.357) exhibited a significant negative correlation with age, whereas CV (%) (P < 0.001, r = 0.341) and MCA (P=0.008, r = 0.111) exhibited a significant positive correlation. The mean rate of endothelial cell loss from 20 to 85 years of age was 0.3% per year. CONCLUSIONS: Our results provide normative data for the corneal endothelium in healthy Egyptian eyes, thus increasing the knowledge base for corneal endothelial cell parameters in healthy Egyptian eyes. Furthermore, our findings can be used as baseline values for comparisons between Egyptian and other populations and for studies of the endothelial cell reserve and capacity for intraocular surgery and corneal transplantation.

Pediatric self-inflicted eye trauma due to a major depressive disorder.

Self-inflicted eye trauma is a serious form of self-harm as it may lead to irreversible visual disability. Diagnosing self-inflicted ocular injuries, in all its forms, can be quite challenging. In this report, we are presenting a 5-year-old girl presented to Sohag University Outpatient Clinic with a history of repeated attacks of bilateral eye redness with blood-tinged strands removed from her eyes. After ocular examination, inferior bulbar conjunctival injection with blood-tinged strands were found. After careful examination of the strands, it was discovered that they were actual threads of cloth due to self-inflicted eye injury. Following psychiatric consultation, the patient was diagnosed as having a major depressive disorder. The case was subject to pharmacological and psychotherapeutic treatment, and showed significant improvement within two months of starting treatment as regard to depressive symptoms and self-injury behaviors. Although self-inflicted ocular injuries due to pediatric mood disorders are rare, it should be suspected in any case of unexplained chronic conjunctivitis.

Outcomes of Corneal Tattooing by Rotring Painting Ink in Disfiguring Corneal Opacities.

AIM: To evaluate corneal tattooing with Rotring painting ink (Rotring Ink, Hamburg, Germany) as an available and affordable surgical technique to improve cosmetic appearance in the eyes with disfiguring corneal opacities. METHODS: Fifty-three blind eyes with corneal disfiguring opacities underwent corneal tattooing using Rotring painting ink (Rotring Ink, Hamburg, Germany) by multiple transepithelial intrastromal injections under topical anesthesia. Complete ophthalmic examination and ocular ultrasonography were performed, and photographs of the patients' eyes were taken. Follow-up period was at least 12 months. RESULTS: On the first postoperative day, all patients presented with mild conjunctival injection and foreign body sensation. After the end of the follow-up period, 51 patients (96%) were satisfied of cosmetic appearance while only 2 patients (4%) post-op cosmetic results were less than their expectations; however, they were better in appearance. No major complications like corneal erosions; corneal ulcers or corneal melting was noted in any case. CONCLUSIONS: Corneal tattooing with Rotring painting ink in blind disfigured eyes achieves favourable cosmetic results and is associated with high patient satisfaction. With better case selection, a high post-op satisfaction was achieved. Corneal tattooing acts as an alternative to more sophisticated and expensive cosmetic reconstructive surgery. This trial is registered with ISRCTN46626979.