Suture-related complications after deep anterior lamellar keratoplasty for keratoconus.

PURPOSE: The purpose of this study is to determine the incidence of suture-related complications, their risk factors, and effects on the clinical outcomes after deep anterior lamellar keratoplasty (DALK) for keratoconus. METHODS: In this retrospective, comparative, interventional study, the records of consecutive patients with keratoconus who underwent DALK were reviewed for suture-related complications. Univariate analyses were used to identify risk factors for suture complications. We compared groups with and without suture-related complications to evaluate the effects of these complications on clinical outcomes after DALK. RESULTS: Of the 633 DALKs, 438 eyes (69.2%) developed suture complications including loose sutures (32.7%), spontaneous suture rupture (30%), sterile suture abscesses (22.8%), suture tract vascularization (16.4%), suture erosion (10.3%), and suture cheese wiring (6.8%). Vernal keratoconjunctivitis increased the incidence of sterile suture infiltration, premature suture loosening, and suture tract vascularization. Loose suture was observed more commonly in larger graft size, while spontaneous suture rupture was associated with late suture removal. There was no statistically significant difference in postoperative outcomes including visual acuity, refraction, graft rejection, and failure in eyes with and without suture complications. However, suture-related complications were directly associated with sight-threatening ocular morbidities, including graft rejection (39 eyes), ulcer (1 eye), and failure (2 eyes). CONCLUSION: Suture-related complications frequently occurred after DALK for keratoconus. Ocular surface inflammation, large grafts, and late suture removal increased the risk of suture-related complications. While these complications had no negative impact on clinical outcomes in the majority of cases, some of them led to sight-threatening morbidity, underlining the importance of early diagnosis and treatment.

CHANGES IN CENTRAL CHOROIDAL THICKNESS AFTER TREATMENT OF DIABETIC MACULAR EDEMA WITH INTRAVITREAL BEVACIZUMAB CORRELATION WITH CENTRAL MACULAR THICKNESS AND BEST-CORRECTED VISUAL ACUITY.

PURPOSE: To assess the effect of intravitreal injection of bevacizumab on central choroidal thickness (CCT) and its relationship with central macular thickness (CMT) and best-corrected visual acuity (BCVA) changes in eyes with center-involving diabetic macular edema. METHODS: This prospective interventional case series included 20 eyes of 20 patients with center-involving diabetic macular edema naive to treatment. The BCVA assessment, complete eye examination, enhanced depth optical coherence tomography, and fluorescein angiography were performed at baseline followed by 3 monthly intravitreal injection of bevacizumab. The treated eyes underwent BCVA evaluation and enhanced depth optical coherence tomography at Months 1, 2, 3, and 6 after the first injection. Change of the CCT was the primary outcome measure. Secondary outcome measures included BCVA and CMT changes and their relationship with CCT changes. RESULTS: Mean age of patients was 63.1 ± 8.0 (range, 52-75) years. Mean baseline CCT was 265 ± 79 µm, which reduced to 251 ± 81 µm and 232 ± 82 µm at Months 3 and 6, respectively (P < 0.001). Corresponding values for CMT were 470 ± 107 µm, 392 ± 104 µm, and 324 ± 122 µm, respectively (P < 0.001). The BCVA improved from 20/60 at baseline to 20/50 at Month 3 and 20/40 at Month 6 (P = 0.007). Each 1 µm decrease in CCT was associated with 2.74 µm reduction in CMT and 0.1 Early Treatment Diabetic Retinopathy Study letter score improvement in BCVA (P < 0.001 and P = 0.001, respectively). CONCLUSION: After treatment of diabetic macular edema with intravitreal injection of bevacizumab, CCT decreased and this reduction significantly correlated with CMT reduction and vision improvement.

Risk Factors for Pterygium in Ilam Province, Iran.

PURPOSE: To evaluate the risk factors for pterygium in the dry, high altitude province of Ilam, Iran. METHODS: The study included patients who presented to ophthalmology clinic. The patients were divided into two groups: 210 diagnosed with pterygium or pinguecula (unilateral or bilateral), and 210 healthy controls. Demographic variables, living environment, disease type, disease laterality, family history of pterygium as well as history of smoking, working outdoors, baking, welding, ocular conditions (trachoma keratopathy, glaucoma, refractive error, and dry eye), use of glasses, ultraviolet light exposure, and systemic conditions were collected from both groups and compared for risk assessment. RESULTS: Univariate analysis revealed that age (P = 0.001), sex (P = 0.001), family history of pterygium (P = 0.001), positive history of smoking (P < 0.001), history of baking (P = 0.045), welding experience (P < 0.001), severe blepharitis (P < 0.001), hyperopia (P < 0.001), dry eye (P < 0.001), hypertension (P < 0.001), ischemic heart disease (P < 0.001), obesity (P = 0.038), and primary residential area (P = 0.025) had significant associations with increased incidence of pterygium. However, in multivariate analysis, only family history of pterygium, cigarette smoking, history of baking, age, and severe blepharitis were significantly associated with the incidence of pterygium (P<0.001, P<0.001, P = 0.002, P = 0.023 and P = 0.002, respectively). CONCLUSION: This study tested more risk factors related to the prevalence of pterygium compared to previous studies. It also confirmed previously established risk factors. Family history of pterygium and blepharitis were risk factors that have not been reported in previous studies and were found to be significantly associated with the development of pterygium in this study.

Visual Outcomes after Primary Iris Claw Artisan Intraocular Lens Implantation during Complicated Cataract Surgery.

PURPOSE: To evaluate the efficacy and safety of aphakic Artisan-Verysise intraocular lens (IOL) primarily implanted for complicated cataract surgery. METHODS: A retrospective analysis of 49 eyes that underwent primary aphakic Artisan IOL implantation for complicated cataract surgery. Pre- and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalents (SE) were compared. RESULTS: The mean age of the participants was 68 ± 12.7 years, and the mean follow-up time was 30.7 ± 14.8 months. The mean BCVA improved significantly from 0.58 ± 0.4 at baseline to 0.44 ± 0.41 after the operation (P = 0.008). The spherical equivalent changed insignificantly from -0.13 ± 1.55 preoperatively to -0.6 ± 1.88 (P = 0.724) at the last visit. Postoperative complications were transient pigmented precipitates in five cases and raised intraocular pressure in one case. CONCLUSION: Aphakic Artisan IOLs are attractive alternatives in complicated cataract surgery without sufficient capsular bag support.

Visual outcomes after lensectomy and iris claw artisan intraocular lens implantation in patients with Marfan syndrome.

PURPOSE: To review our experience with crystalline lens extraction and iris claw Artisan IOL implantation in patients with lens subluxation secondary to Marfan syndrome. METHODS: A retrospective analysis of 12 eyes of 9 patients with lens subluxation due to Marfan syndrome who underwent crystalline lens removal and Artisan IOL (Ophtec, Groningen, Netherlands) implantation. A questionnaire of pre- and post-operative data, including demographics, pre- and postoperative comorbidities and complications was completed. Patients were evaluated for visual outcome and occurrence of complications. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalents (SE) were compared before and after lens extraction and IOL insertion. RESULTS: The mean age of the participants was 30.03 ± 15.02 years, and mean post-operative follow-up time was 44.5 ± 16.4 months. Mean BCVA also showed a significant improvement from 0.5 ± 0.3 at the baseline to 0.2 ± 0.2 post-operatively (P = 0.006). SE changed significantly from -11.38 ± 1.99 preoperatively to -0.45 ± 1.65 post-operatively (P = 0.003). All eyes had the IOL implanted at desired position. Post-operative complications were retinal detachment in one case and IOL dislocation in another patient. No other complication such as ocular hypertension, angle abnormalities, clinical cystoids macular edema, and corneal decompensation was observed during the follow-up period. CONCLUSION: Artisan IOL implantation after lens extraction appears to be an attractive alternative for optical correction in cases of Marfan syndrome with ectopia lentis. It confers a significant improvement in visual acuity with reasonable risk profile.

Intraocular lens power calculation after corneal refractive surgery.

PURPOSE: To report refractive outcomes following phacoemulsification (PE) and posterior chamber intraocular lens (PCIOL) implantation in eyes with previous corneal refractive surgery. METHODS: In this retrospective comparative study, 18 consecutive eyes of 14 patients with previous keratorefractive surgery for myopia including photorefractive keratectomy (PRK, 6 eyes; 33.3%) and laser in situ keratomileusis (LASIK, 12 eyes; 66.7%) underwent PE+PCIOL. Computerized corneal topography was employed to determine the flattest keratometric reading within the 3-mm central zone. This value was inserted into the Sanders-Retzlaff-Kraff/T (SRK/T) formula to calculate IOL power. IOL power selected for implantation was 1 D greater than the calculated value described above. RESULTS: Mean age and follow-up period were 54.1±11.5 years and 29.9±26.3 months, respectively. Mean implanted lens power was 18.56±3.86 D which was not significantly different from mean back-calculated IOL power for target refraction (19.04±4.16 D) (P=0.28). There was no significant difference between mean target refraction (-0.94±0.52 D) and achieved postoperative spherical equivalent refractive error (-0.62±1.06) at final follow-up (P=0.28). The achieved spherical equivalent refractive error was within ±0.50 D of intended refraction in 8 (44.4%) eyes, within ±1.0 D in 11 (61.1%) eyes, and within ±2.0 D in 16 (88.9%) eyes. In a subgroup of patients (5 eyes) with complete pre-refractive surgery data, the difference between post-refractive surgery keratometry method and all other methods (P=0.02) and between the current method and the Feiz-Mannis method (P=0.01) was statistically significant. CONCLUSION: The method suggested herein is simple and independent of pre-refractive surgery data with results comparable to other commonly used methods.