ABSTRACT
PURPOSE: To evaluate the time until astigmatic stabilization after corneal suture removal after cataract surgery. METHODS: A prospective study was performed on 13 patients who had undergone cataract surgery by phacoemulsification with 2.4mm incision, for whom it was felt necessary to remove a corneal suture. A specular corneal topography was performed by OPD Scan before removal, immediately after, then 10, 20, 30 minutes and 15 days later. For each acquisition, the keratometric readings at the steepest (Kmax) and the flattest (Kmin) meridians (central at 1.15 mm from corneal center, intermediate at 2.30 mm and peripheral at 3.30 mm) and the amount of corneal astigmatism were measured. RESULTS: Corneal topography of 13 patients was acquired. Mean age was 70 ± 12 years. Mean time after cataract surgery was 23 ± 14 days. The greatest change in Kmax occurred within the first minutes following suture removal for the central and intermediate cornea (mean variation of -4.38% and -4.59% of initial Kmax respectively, i.e. -2.04 D ± 3.14 D et -2.15 D ± 3.11 D) whereas it was observed between 0 and 10 minutes for the peripheral area (mean 1.57% of Kmax after suture removal i.e. 0.96 D ± 1.85 D). Mean change in corneal astigmatism between 30 minutes and day 15 was 0.08 D ± 0.31 D (3.6% of baseline). When suture removal was performed between 7 and 10 days postoperatively, mean change was 0.16 D ± 0.24 D, whereas it was 0.03 D ± 0.34 D when performed after four weeks. CONCLUSION: Keratometric readings vary only slightly beyond the first 30 minutes after suture removal. These results suggest that the refraction could be accurately measured the same day as suture removal, with no additional follow-up absolutely necessary in order to prescribe the final spectacles.
Subject(s)
Astigmatism/etiology , Cataract Extraction , Postoperative Complications/etiology , Sutures , Aged , Aged, 80 and over , Corneal Topography , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Familial amyloid polyneuropathy (FAP) or transthyretin (TTR) amyloid polyneuropathy is a progressive sensorimotor and autonomic neuropathy of adult onset, which is transmitted as an autosomal dominant trait. In addition to neurologic symptoms, FAP may be associated with weight loss, cardiac and renal failure and ocular complications. FAP is a devastating disease, causing death within 10years after the first symptoms. The TTR Val30Met mutation is the most common of more than 100 amyloidogenic mutations identified worldwide. Liver transplantation (LT) is currently the only treatment for preventing synthesis of the amyloidogenic variants of TTR. LT can halt progression of the neuropathy in up to 70% of cases and doubles the overall median survival of young Val30Met patients. Oral administration of tafamidis, which prevents deposition of mutated TTR, is now available to delay neurologic complications in early stages of the disease. Ocular manifestations of FAP are frequent and mainly include keratoconjunctivitis sicca, secondary glaucoma, vitreous deposits and pupillary abnormalities. Retinal and choroidal vascular abnormalities are more rare. Since ocular TTR is synthesized, at least in part, in the retinal pigment epithelium, LT does not influence the course of ocular involvement. The effects of tafamidis on the latter are still unknown. Because LT and symptomatic treatments greatly improve life expectancy of patients with FAP, ocular involvement is becoming a more frequent challenge to address. This review summarizes the pathophysiology, clinical findings and possible treatments of ocular manifestations of FAP.
Subject(s)
Amyloid Neuropathies, Familial/complications , Eye Diseases, Hereditary/etiology , Adult , Amyloid Neuropathies, Familial/diagnosis , Amyloid Neuropathies, Familial/epidemiology , Eye/metabolism , Eye Diseases, Hereditary/diagnosis , Eye Diseases, Hereditary/epidemiology , Glaucoma/genetics , Humans , Iris Diseases/genetics , Prealbumin/metabolismABSTRACT
Neurotrophic keratopathy is a potential consequence of herpes simplex virus (HSV) or varicella zoster virus (VZV) infection. The treatment is based on artificial tears and the withdrawal of preserved eye drops or other types of epitheliotoxic topical medicines. Autologous serum or amniotic membrane transplantation may also be used in severe cases, but their cost and safety are still under debate. We report a case of a patient with a history of herpes zoster ophthalmicus, who developed a persistent epithelial ulcer after cataract surgery, with no improvement despite 3 weeks of artificial tears (eight drops per day). A new ophthalmologic solution based on a regenerating agent (RGTA, Cacicol20(®)) was then used, with a dosage of two eye drops per week for 6 weeks. Improvement was observed 1 week later, and complete healing was obtained in less than 3 weeks, with no side effects. This heparin mimetic, which may stimulate extracellular matrix healing, may be a possible alternative therapy to autologous serum or amniotic membrane transplantation in severe neurotrophic ulcer. However, randomized studies are necessary to validate this observation.
