Optical coherence tomography findings in idiopathic macular holes.

Purpose. To describe the characteristics of idiopathic macular holes (MH) on optical coherence tomography (OCT) and correlate OCT with clinical assessment. Design. Cross-sectional chart review and OCT assessment. Participants. Sixty-seven eyes with a clinically diagnosed idiopathic MH with available OCT data. Methods. A retrospective chart review and OCT assessment. Results. Based on OCT grading, 40 eyes had a full-thickness macular hole (FTMH) and 21 eyes had a lamellar macular hole (LMH). Clinical exam and OCT assessment agreed in 53 (87%) eyes when assessing the extent of MH. Six eyes (14.6%) in the FTMH group, and 3 eyes in the LMH group (14.3%) had persistent vitreomacular traction. Thirty-seven eyes (92.5%) in the FTMH group and 11 eyes (52.4%) in the LMH group had associated intraretinal cysts. Two eyes (5.0%) in the FTMH group and zero eyes in the LMH group had subretinal fluid. Intraretinal cysts were found to be more frequently associated with FTMH than with LMH (P < 0.001). Conclusion. This paper described OCT findings in a group of patients with clinically diagnosed MH. A high level of correlation between clinical assessment and OCT findings of LMH and FTMH was observed, and intraretinal cysts were often present in FTMH.

Conservative treatment of meibomian gland dysfunction.

PURPOSE: To evaluate the effectiveness of lid hygiene and preservative-free artificial tears for the treatment of meibomian gland dysfunction (MGD) during a 6-week period. METHODS: Suitable patients with MGD were educated about their disease and instructed to begin a regimen of lid hygiene, which included the application of a heated saline solution and the use of nonpreserved artificial tears. Baseline measurements obtained at the time of enrollment included basic tear secretion test, tear breakup time, a questionnaire grading MGD symptoms (i.e., burning, irritation, itching, sharp pains, foreign body sensation, and hazy vision), and lid margin slitlamp photographs. All measurements except for basic tear secretion were repeated at the 6-week follow-up visit. Photographs were unlabeled, and two cornea specialists graded them in a masked fashion for the presence of lid erythema, irregularity, thickness, meibomian gland capping, and telangiectasis. RESULTS: Thirty-seven patients with a clinical diagnosis of MGD were enrolled, and 26 patients (70%) completed the study. Initial measurement of basic tear secretion averaged 17 mm and was more than 10 mm in 81% of eyes. The tear breakup time was prolonged by an average of 3.4 seconds; in 30% of cases, it was normalized to 10 seconds or more. Symptoms improved in 88% of cases; among those, symptoms were graded mild or less in 83%, and none in 39%. Photographs before and after treatment were not significantly different. CONCLUSIONS: In this noncontrolled case-cohort study of selected patients with MGD, lid hygiene and preservative-free artificial tears significantly improved tear breakup time and relieved symptoms of the condition.

Herpes simplex reactivation following laser in situ keratomileusis and subsequent corneal perforation.

PURPOSE: To present a case of corneal perforation secondary to herpes simplex reactivation after laser in situ keratomileusis (LASIK) and its subsequent management. METHODSL A case report of a 69-year-old man who underwent LASIK after penetrating keratoplasty for herpes simplex keratitis (HSK) is presented. RESULTS: The patient is a 69-year-old man who had a penetrating keratoplasty of the right eye 6 years prior for corneal scarring secondary to HSK. A spectacle refraction of -13.25 + 6.00 x 45 yielded 20/60 visual acuity in his grafted eye. LASIK was performed, and the patient's visual acuity without correction on postoperative day 1 was 20/60. Ten days after LASIK, the patient developed thinning of the cornea at the temporal edge of the flap, which perforated the following day. The perforation site was glued with cyanoacrylate adhesive and covered with a soft contact lens. After 7 months, a 4-mm lamellar keratoplasty and conjunctivoplasty was performed. Nine months after surgery, the patient's visual acuity without correction is 20/50 and the graft remains intact. CONCLUSION: Herpes simplex keratitis may be a contraindication for LASIK in postkeratoplasty patients. Bandage contact lenses and cyanoacrylate adhesive can be used successfully to manage the rare complication of corneal perforation after LASIK.