A prospective, randomized clinical study comparing accelerated corneal collagen crosslinking with 5% NaCl hypertonic saline for bullous keratopathy in Asian eyes.

BACKGROUND: We compared the clinical outcomes of accelerated corneal collagen crosslinking (CXL) and 5% NaCl hypertonic saline (HS) for the treatment of symptomatic bullous keratopathy (BK). METHODS: A randomized controlled trial was held at Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan. Twenty-three eyes of 23 consecutive patients with symptomatic BK were enrolled. The etiology of BK included pseudophakic BK, previous keratoplasty, previous endotheliitis, previous glaucoma surgery, trauma, herpes infection, as well as unknown causes. Eleven eyes received epi-off accelerated CXL (with epithelial abrasion and 18 mW/cm ultraviolet A irradiation for 5 minutes) and 12 eyes received HS instillation. In addition to the usual ophthalmic examination, the best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were determined. The CCT was measured using anterior segment optical coherence tomography before and up to 6 months after treatments. Subjective symptoms of pain, blurred vision, photophobia, and irritation were also recorded. RESULTS: The follow-up was completed for all patients in the CXL group. However, 6 patients in the HS group requested CXL treatments after 3 months. The BCVA was not significantly changed during the study periods in both groups. The CCT was significantly thinner in the CXL group compared to the HS group at 1 and 6 months (P = .015 and 0.144, respectively). Among the subjective symptoms recorded, irritation was significantly lower in the CXL group at 1 month (P = .013). CONCLUSIONS: Accelerated CXL may produce transient improvement in pain and corneal edema in patients with BK.

Corneal cross-linking for keratoconus caused by compulsive eye rubbing in patients with Tourette syndrome: Three case reports.

RATIONALE: Eye rubbing is an important risk factor for keratoconus progression. Tourette syndrome (TS) is a neurological disorder, and approximately 50% of individuals with TS exhibit obsessive-compulsive behaviors including eye rubbing. We report the effects of corneal cross-linking (CXL) on the progression of keratoconus combined with psychiatric treatment for 3 patients with TS. PATIENTS' CONCERNS: Three cases, 24-year-old male, 14-year-old male, and 17-year-old male, were all referred to our institute, due to decreased visual acuity. DIAGNOSIS: All 3 patients were diagnosed with progressive keratoconus. They were found to rub their eyes, and were also diagnosed with TS by psychiatrists. INTERVENTION: Upon diagnosis of keratoconus, we performed CXL on 1 eye of each patient. OUTCOMES: After CXL, there was no further progression. Psychiatric medication was also required. LESSONS: For patients with keratoconus caused by eye rubbing due to TS, CXL seems to be effective when done in association with psychiatric treatment.

Corneal crosslinking for keratoconus in Japanese populations: one year outcomes and a comparison between conventional and accelerated procedures.

PURPOSE: We retrospectively investigated the efficacy of corneal crosslinking (CXL) on progressive keratoconus in a Japanese population and compared the outcomes of conventional and accelerated CXL. STUDY DESIGN: A retrospective cohort study METHODS: A total of 108 consecutive eyes in 95 patients (75 men; 21.9 ± 6.2 years) with progressive keratoconus were enrolled. The epithelium was ablated in all eyes. After presoaking the corneal stroma in riboflavin, UV-A was irradiated at 3.0 mW/cm2 (conventional CXL) for 30 min on 23 eyes and 18.0 mW/cm2 for 5 min (accelerated CXL) on 85 eyes. Best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometric value, corneal thickness, corneal endothelial cell density (ECD), intraocular pressure, and complications were evaluated at 1, 3, 6, and 12 months after the procedure. RESULTS: BSCVA, manifest refraction, ECD, and corneal thickness did not change significantly after both procedures. The keratometric value was significantly decreased from the preoperative value at 12 months (p < 0.001). Progression to more than 1.0 D after CXL was observed in 10 eyes (9.3%). The ΔKmax was negatively associated with preoperative Kmax (p < 0.001) and positively associated with preoperative thinnest corneal thickness (p < 0.001). Both treatment modules showed no significant difference in all parameters. CONCLUSION: CXL was as effective in treating keratoconus in Japanese patients as in individuals of other ethnicities. Overall, CXL could be performed using either the conventional or accelerated approach to halt the progression of keratoconus in Japanese populations.

Flattening effect of corneal cross-linking depends on the preoperative severity of keratoconus.

A retrospective observational study was conducted to validate the effect of corneal cross-linking (CXL) on eyes with progressing keratoconus, depending on severity.In total, 45 eyes of 33 patients (age: 23.9 ±â€Š6.8 years, range: 14-42 years) with progressive keratoconus who underwent CXL were enrolled. Examinations were performed at pre-, 1, 3, 6, and 12 months after surgery. In addition to a slit lamp microscopy, measurement of visual acuity, the steepest keratometric value (Kmax), the thinnest corneal thickness (TCT), and the corneal endothelial cell density (ECD) were assessed. Change in Kmax (ΔKmax) was calculated by subtracting the preoperative Kmax from the 12-month postoperative Kmax.CDVA, TCT, and ECD did not change significantly throughout the follow-up period. Kmax was 56.4 ±â€Š7.2 D preoperatively and 54.3 ±â€Š5.6 D at 12 months after CXL (P = .174). The average value of ΔKmax was -2.23 ±â€Š4.31 D at 12 months after CXL. ΔKmax was negatively correlated with preoperative Kmax (ρ = -0.5517, P = .0001), and positively correlated with preoperative TCT (ρ = 0.4791, P = .0012). However, no correlation was observed between Kmax and patient age or the decrease ratio of ECD.The more flattening was obtained after CXL in cases with the more advanced keratoconus. No complication, including corneal endothelial damage, was observed even in advanced cases.

Periorbital Pilomatrixoma: a Report of a Case Difficult to Diagnose.

Background: Pilomatrixoma is a benign tumor that arises from matrix cells of hair follicles. In ophthalmology, pilomatrixoma is relatively rare, yet there are reports on eyelid pilomatrixomas that were visible and/or palpable. Our case is the first report on pilomatrixoma that was found as a subconjunctival lesion and neither readily visible or palpable. Case: A 32-year-old woman presented with a chief complaint of conjunctival hyperemia of the left eye with sensation of foreign body. A previous doctor suspected allergic conjunctivitis, but the prescribed antihistamine treatment had failed. Physical exam revealed hyperemia localized to the left temporal bulbar conjunctiva, as well as a 5 mm-diameter hard mass located underneath the lateral palpebral conjunctiva. With a suspicion of inflammatory reaction to a foreign body, enucleation of the mass was performed by opening and detaching the conjunctiva using surgical scissors. Findings: The mass was hard, spherical and 5 mm×10 mm in size without adhesions. The pathology revealed hair follicles, basophilic cells, as well as shadow/ghost cells, which led to the definitive diagnosis of pilomatrixoma. Conclusion: Pilomatrixoma is a benign tumor that arises from matrix cells of hair follicles. This case shows that pilomatrixoma from lateral canthus can extend underneath the conjunctiva.

Measurement of early changes in anterior chamber morphology after cataract extraction measured by anterior segment optical coherence tomography.

OBJECTIVE: To evaluate the serial changes in anterior chamber depth (ACD) and angle parameters early after cataract surgery using anterior segment optical coherence tomography (ASOCT). METHODS: This was a retrospective chart review, case-control study; 150 eyes of 106 patients who underwent cataract surgery. Based on ACD and angle findings, the eyes were classified into two groups, open-angle eyes (87 eyes) and narrow-angle eyes (63 eyes). ASOCT was used to measure ACD and angle parameters (angle opening distance, angle recess area, trabecular iris space area, and trabecular iris angle (TIA [1]). Serial changes in each group were measured before and 1 day, 1 week, and 1 month after cataract surgery, and the differences between the two groups were compared. RESULTS: ACD and all angle parameters in both groups at each examination time after cataract surgery were significantly different from the preoperative values (p < 0.01). In addition, all angle parameters significantly differed between the two groups at each examination time after cataract surgery (p < 0.001). However, ACD after surgery was not significantly different, irrespective of ACD before surgery. ACD and TIA500 both showed significantly greater changes from before surgery to 1 day after surgery in narrow-angle eyes compared to open-angle eyes (p < 0.001). CONCLUSIONS: Cataract surgery increases ACD and all angle parameters early after the surgery. However, the degree of angle widening in narrow-angle eyes was not as much as that in open-angle eyes, suggesting that factors other than the lens influence the angle closure.

Spectral domain optical coherence tomography and angiographic findings in multifocal posterior pigment epitheliopathy treated with low-fluence photodynamic therapy.

PURPOSE: The aim was to evaluate spectral domain optical coherence tomographic (SD-OCT), fluorescein angiography (FA) and indocyanine green angiography (ICGA) findings in multifocal posterior pigment epitheliopathy (MPPE) treated with low-fluence photodynamic therapy. METHODS: A 54-year-old Japanese man with serous retinal detachment (SRD) and pigment epithelial detachment (PED) due to multifocal posterior pigment epitheliopathy in the right eye was managed with ICGA-guided low-fluence photodynamic therapy. Outcome measures included visual acuity, SD-OCT appearance and FA and ICGA findings. RESULTS: The patient received low-fluence photodynamic therapy within two weeks after the onset of symptoms. After treatment, serous retinal detachment and PED resolved in two weeks. Visual acuity returned to 1.0, the external limiting membrane and the photoreceptor inner and outer segment junction integrity were restored and the subfoveal choroidal thickness was greatly reduced. There has been no recurrence in six months. FA demonstrated stoppage of leakage and ICGA showed a marked decrease of choroidal venous dilation and vascular hyperpermeability. CONCLUSION: To our knowledge, this is the first report to examine photoreceptor integrity, foveal choroidal thickness and choroidal circulation in a case of MPPE treated with low-fluence photodynamic therapy. Early application of the photodynamic therapy led to restoration of photoreceptor integrity with improvement of choroidal thickness and circulation.