Photoactivated chromophore corneal cross-linking (PACK-CXL) for treatment of severe keratitis.

PURPOSE: To report our experience with photoactivated chromophore corneal cross-linking (PACK-CXL) for treating keratitis patients. METHODS: This retrospective study consists of 27 eyes of 26 patients with infectious keratitis treated with PACK-CXL at the Helsinki University Hospital between 2009 and 2017. Patients were treated with antibiotics/antifungal medications and underwent PACK-CXL procedure due to lack of clinical response or severe corneal melts. For twenty patients, amniotic membrane transplant (AMT) was done during the same day. Follow-up after cross-linking ranged from 1 week to 12 months. RESULTS: Sixteen infections were related to contact lens wear. Of the 19 eyes showing positive culture, the predominant micro-organism was Pseudomonas aeruginosa (9 cases). The average re-epithelization time was 13 days and in 15 cases (56%) the re-epithelization occurred within one week. In 26 eyes, visual acuity increased and seven patients (26%) had a final visual acuity more or equal to 0.5 (20/40) Snellen. CONCLUSIONS: PACK-CXL seems to be a safe and potential option for treating patient with infectious keratitis who do not respond to antibiotic therapy.

Bilateral Ectasia After Femtosecond Laser-Assisted Small Incision Lenticule Extraction (SMILE).

PURPOSE: To describe a case of bilateral ectasia after small incision lenticule extraction (SMILE) in a patient with early keratoconus. METHODS: Case report. RESULTS: Bilateral SMILE was performed on a patient even though preoperative topographies showed changes indicating early keratoconus. The right eye underwent further photorefractive keratectomy enhancement 18 months later. The patient developed a bilateral corneal ectasia. CONCLUSIONS: This case underlines the importance of thorough preoperative assessment for possible keratoconus suspect changes with corneal topography to avoid postoperative ectasia. [J Refract Surg. 2016;32(7):497-500.].

Penetrating keratoplasty for corneal amyloidosis in familial amyloidosis, Finnish type.

PURPOSE: To analyze the outcome of penetrating keratoplasty (PK) to the first eye for corneal amyloidosis in familial amyloidosis, Finnish type (FAF). DESIGN: Single-center, retrospective, nonrandomized, interventional, noncomparative case series. PARTICIPANTS: Thirty-one eyes of 31 patients with FAF. INTERVENTION: All patients with FAF who had their first PK in Helsinki University Eye Hospital between January 1, 1990, and August 1, 2011, were identified and a retrospective analysis of the patient charts was performed. MAIN OUTCOME MEASURES: Best spectacle-corrected visual acuity (BCVA), intraoperative and postoperative complications, graft survival, reason for graft failure, and frequency of regrafting. RESULTS: The median follow-up period was 32 months (range, 5-114). After 24 months, the median BCVA was 1.15 on a logarithm of the minimum angle of resolution scale (20/280; mean, 1.1; SD, 0.5) in comparison with the preoperative median BCVA of 1.3 (20/400; mean, 1.3; SD, 0.4). At 24 months, 3 of 18 eyes (17%) had a visual acuity of ≥0.5 (20/63) and 13 of 18 grafts (72%) were clear. Rejection occurred in 6 of 31 primary grafts (19%). Graft failure occurred in 16 of 31 eyes and resulted from surface complications in 11 eyes and additionally from rejection in 5 eyes. Seven eyes needed regrafting (twice in 1 eye). Complications were frequent in the early and late postoperative periods. Presence of preoperative corneal or graft neovascularization was an indicator of a high risk of graft failure and poor visual outcome. CONCLUSIONS: In a minority of FAF patients, PK improves vision. Owing to the high failure risk and guarded visual prognosis after PK, it is important that both the surgeon and the patient have realistic expectations. It may be reasonable to limit PK to cases with bilateral advanced disease. It seems reasonable to optimize ocular surface health and to delay PK.

[Keratitis associated with contact lens wear]. / Piilolinssien käyttöön liittyvät sarveiskalvotulehdukset.

Keratitis is a rare complication associated with contact lens wear, always presenting a threat to the patient's vision. In most cases the patients seek medical care for a painful, reddened eye that is watering or produces discharge. In most cases a light-colored lesion staining with fluorescein is seen on the cornea. The most common causative organism is Pseudomonas aeruginosa. Representative culture specimens from the cornea and conjunctiva as well as from the contact lens are important in respect of directing the treatment. Even if the inflammation can in most cases be treated, keratitis always leaves a scar on the cornea and may require further surgical interventions to restore patients vision.