Corneal densitometry after accelerated corneal collagen cross-linking in progressive keratoconus.

PURPOSE: To analyze changes in corneal densitometry 3 months after accelerated corneal collagen cross-linking (CXL) measured with Scheimpflug tomography. METHODS: In this study we reviewed charts and anterior segment data of patients who had undergone accelerated pulsed epithelium-off CXL (30 mW/cm2 for 4 min, 8 min total radiation time) for treatment of progressive keratoconus in the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Visual, topographic, pachymetric and densitometric data were extracted before surgery and at the 3-month follow-up. Corneal densitometry measurements from different corneal layers and zones obtained using Scheimpflug tomography (Pentacam HR, Oculus). RESULTS: The study investigated 12 eyes of 12 patients. The anterior (120 µm) stromal layer within the 0.0 to 2.0 mm and 2.0 to 6.0 mm concentric zones showed a significant elevation of mean densitometry 3 months post-surgery (P = 0.045; P = 0.015) compared to baseline. A mean stromal demarcation line was apparent at a depth of 203.00 µm ± 13.53 (SD). After accelerated CXL, no change in mean corrected distance visual acuity (LogMAR) was observed but a thinning of the cornea measured by a significant reduction in central pachymetry (µm). CONCLUSION: Accelerated CXL results in an increase in corneal densitometry, particularly in the anterior stromal layer within the two central concentric zones (0.0 to 2.0 mm and 2.0 to 6.0 mm) of the cornea at 3 months postoperatively. The changes in corneal densitometry of the anterior stromal layer did not correlate with postoperative visual acuity or central pachymetry.

Short-term complications of femtosecond laser-assisted laser in situ keratomileusis cuts: Review of 1210 consecutive cases.

PURPOSE: To evaluate short-term complications after femtosecond laser cuts for laser in situ keratomileusis (LASIK). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective consecutive case series. METHODS: Consecutive femtosecond laser cuts (1210 cuts in 624 patients) from LASIK performed with the Intralase FS60 between 2006 and 2014 were analyzed. The analysis looked at intraoperative and postoperative complications at 1 day, 1 week, and 1 month and factors with potential impact on the complication rate, such as ablation depth. RESULTS: No irregular, incomplete, or thin flaps, buttonholes, gas breakthrough, or free caps were observed. Intraoperatively, incomplete side cuts were observed in 4 cases (0.3%). Three of the 4 occurred during the first year of femtosecond laser usage and were explained by a software problem. Epithelial defects, limbal bleeding, and decentered flaps without negative impact on outcome were observed in 45 (3.7%), 12 (1.0%), and 5 (0.4%) eyes, respectively, on the treatment date. Diffuse lamellar keratitis (DLK) stage 1 was observed in 69 (5.7%), 36 (3.0%), and 3 (0.2%) eyes at 1 day, 1 week, and 1 month, respectively, and DLK stage 2 in 20 (1.7%), 6 (0.5%), and 2 (0.2%) eyes, respectively. An increase in total ablation depth resulted in a higher incidence of microstriae (P < .01 at 1 day, 1 week, and 1 month). An increase in the optical zone resulted in a significantly higher incidence of epithelial ingrowth at 1 day and 1 week (P < .01). CONCLUSION: No major cut-related complications were observed. The femtosecond laser is a safe option to create a flap in LASIK. FINANCIAL DISCLOSURE: Proprietary or commercial disclosures are listed after the references.

Effects of Atopic Syndrome on Keratoconus.

PURPOSE: To evaluate the effects of atopic syndrome on manifestations of keratoconus. METHODS: In this retrospective study, we reviewed patient files and data generated by Scheimpflug imaging of 670 eyes of 434 keratoconus patients. Patients were divided into a study group consisting of patients suffering from atopic syndrome (110 eyes of 75 patients), namely allergic asthma, atopic dermatitis, and/or allergic rhinitis, and a control group of patients without known atopic syndrome (560 eyes of 359 patients). RESULTS: We found a significant difference with the mean age being 36.1 ± 11.7 for the control group, 32.8 ± 9.6 for the atopic group (P = 0.002) with 1 atopic trait, and 30.4 ± 7.5 for patients with 2 or more atopic traits (P = 0.002). No statistically significant differences were found in the mean corrected distance visual acuity, corneal pachymetry, minimum relative pachymetric progression (RPImin), mean refraction, keratoconus index, anterior chamber depth and volume, Kmax, and location of Kmax in relation to the corneal apex. However, we found a significantly higher corneal density for the anterior 120 µm of the cornea in the atopic group (control: 20.74 ± 4.68, atopic group: 21.92 ± 4.65 P = 0.016). CONCLUSIONS: Keratoconus patients suffering from atopic syndrome were significantly younger but showed no topographical changes except in corneal densitometry compared with keratoconus patients without an atopic disease. This suggests atopic syndrome is a factor, which can trigger earlier manifestation of keratoconus.

Comparing Different Decontamination Procedures in Harvesting Human Donor Cornea.

PURPOSE: To evaluate the effects of current hygiene standards for the enucleation of postmortem eyes by investigating the number of microorganisms during subsequent steps of decontamination and tissue processing. MATERIALS AND METHODS: This prospective, non-randomized cohort study includes 184 postmortem eyes of 92 human donors. Enucleation was performed, according to an ophthalmic surgical procedure. Two groups were generated as follows: right eyes were allocated to group A, left eyes were allocated to group B. In group A, a mucosal disinfectant was used accessorily. Conjunctival smears were taken to examine germ load in both groups before any intervention, in group A after mucosal disinfection, in both groups after transportation of the whole globes in transport fluid, and in both groups after a bath in 0.75% povidone iodine solution for at least 3 minutes just before preparation of the corneoscleral disc. Smears were sent to the local microbiologic laboratory in an aseptic package for testing. RESULTS: All smears showed multiple contaminations (n = 184/184 eyes) before treatment with povidone iodine solution. Contamination was in both groups significantly prevented using the treatment strategy of an at least 3-minute bath in 0.75% povidone iodine solution (n = 1/184 eyes; p < 0.01) As a side effect, almost every eye of group A and none of group B showed brown iodine staining corresponding to corneal epithelial erosion. CONCLUSIONS: An aseptic setting for donor enucleation similar to a surgical procedure seems not to influence the outcome of germ colonization. The most effective step to decontaminate donor eyes is to use 0.75% povidone iodine solution for at least 3 minutes.

Comparison of intravitreal bevacizumab upload followed by a dexamethasone implant versus dexamethasone implant monotherapy for retinal vein occlusion with macular edema.

PURPOSE: To compare the efficacy and safety of three intravitreal bevacizumab upload injections followed by a dexamethasone implant versus dexamethasone implant monotherapy in eyes with macular edema due to retinal vein occlusion. METHODS: Sixty-four eyes of 64 patients were included in this prospective, consecutive, nonrandomized case series: group 1 consisted of 38 patients (22 with central retinal vein occlusion, CRVO, 16 with branch retinal vein occlusion, BRVO) treated using a dexamethasone implant (Ozurdex) alone; group 2 consisted of 26 patients (14 CRVO, 12 BRVO) treated with three consecutive intravitreal bevacizumab injections at monthly intervals followed by a dexamethasone implant. In case of recurrence, both cohorts received further dexamethasone implants. Preoperatively and monthly best corrected visual acuity (BCVA, ETDRS), central retinal thickness (Spectralis-OCT), intraocular pressure, and wide-angle fundus photodocumentation (Optomap) were performed. The primary clinical endpoint was BCVA at 6 months after initiation of therapy. Secondary endpoints were central retinal thickness and safety of the therapy applied. RESULTS: In group 1, an increase in BCVA of 2.5 (±1.6) letters in the CRVO and of 13.0 (±3.2) letters in BRVO patients was seen after 6 months, in group 2 of 5.9 (±0.4) letters (CRVO) and 3.8 (±2.4) letters (BRVO), which was not statistically significant. When comparing the two treatment groups with respect to the type of vein occlusion, there was a significant advantage for BRVO patients for the dexamethasone implant monotherapy (BRVO patients in group 1, p = 0.005). Central retinal thickness showed a significant reduction after 6 months only in patients of group 1, both for CRVO (p = 0.01) and BRVO (p = 0.003). First recurrence after the first dexamethasone implant injection occurred after 3.8 months (mean) in CRVO and 3.5 months in BRVO patients (group 1), versus 3.2 and 3.7 months, respectively, in group 2. In group 1, 63.6% with CRVO and 50% with BRVO showed an increased intraocular pressure after treatment; in group 2, 57.1% with CRVO and 50.0% with BRVO, respectively. CONCLUSION: In CRVO, there was no difference between the two treatment strategies investigated. However, in BRVO, dexamethasone implant monotherapy was associated with better functional outcome.

Ocular fat embolism syndrome.

Ocular fat embolism syndrome in the complete absence of any cardiac defects is a rare phenomenon which is not commonly encountered in ophthalmic practice. We present a case of a 16-year-old girl with fat embolism syndrome and involvement of the retina after a tibial fracture without any cardiac defect.

Efficacy and safety of hyaluronidase 75 IU as an adjuvant to mepivacaine for retrobulbar anesthesia in cataract surgery.

PURPOSE: To evaluate the efficacy and safety of hyaluronidase as an adjuvant to mepivacaine for retrobulbar anesthesia in cataract surgery. SETTING: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, and Eye Center Munich East, Munich-Haar, Germany. METHODS: Eyes having cataract surgery at 1 of the 2 centers were included in this prospective randomized double-blind placebo-controlled clinical trial. Retrobulbar anesthesia was administered by the surgeon using a solution of 5 mL mepivacaine 1% with additional hyaluronidase (Hylase Dessau) 75 IU (40 eyes) or additional placebo (40 eyes). The main target parameter was akinesia 5 minutes after administration of the study medication. Secondary parameters were akinesia at later times, additional injections, ptosis of the upper eyelid, time to reach complete anesthesia, assessment of pain using a visual analog scale, assessment of efficacy and tolerability by the patient and the surgeon, and adverse events. RESULTS: Complete akinesia 5 minutes after retrobulbar injection was reached in significantly more cases in the hyaluronidase group (29) than in the placebo group (13) (P < .001). Additional injections were necessary in 5 placebo-treated eyes. The administration of hyaluronidase yielded significantly better results than the placebo in terms of ptosis, time to reach complete anesthesia, assessment of efficacy, tolerability, and postoperative pain. No adverse events occurred in either group. CONCLUSION: The addition of hyaluronidase to mepivacaine for retrobulbar anesthesia in cataract surgery enhanced the safety of the surgical procedure due to more complete akinesia and quicker onset of complete anesthesia.