Initial experiences using plasma rich in growth factors to treat keratoneuralgia.

Keratoneuralgia, a clinical diagnosis of sensitized corneal pain without visible ocular surface damage, generally has minimal response to conventional therapies. Causes include refractive surgery and chronic dry eye. We evaluated the efficacy of Plasma Rich in Growth Factors (PRGF), a novel treatment prepared using a commercially available kit, in patients with keratoneuralgia. A retrospective chart review identified patients who had the clinical diagnosis of keratoneuralgia and were treated with PRGF for at least 3 months from October 2015 to April 2020 at a single academic institution. Both objective eye exam findings and concurrent treatments were obtained at baseline, 3 months, and final visit (if available). A questionnaire was administered to identified patients, including symptoms scores measured with a visual analog scale. The results of this survey and other objective findings were compared before and after PRGF treatment. 16 out of 32 patients (50%) with a mean follow-up period of 33 ± 26 months answered the questionnaire. Refractive surgeries were the cause of keratoneuralgia in 14 patients (87.5%), with LASIK the most common procedure (11 patients, 69%). There were no adverse events recorded or reported. Symptom scored by VAS in a modified Symptoms Assessment in Dry Eye questionnaire significantly decreased after PRGF use (85 ± 16 to 45 ± 33, p = 0.0002). Ten patients (63%) reported PRGF is superior to other therapy and would recommend to others. There were no significant trends in visual acuity, objective exam findings, or concurrent treatments after PRGF treatment. PRGF is safe and can potentially alleviate symptoms in patients with keratoneuralgia, a rare but devastating complication after refractive surgery. Prospective trial is indicated to explore PRGF as a potentially useful treatment for keratoneuralgia.

DMEK for the treatment of interface fluid syndrome secondary to failed DSAEK graft: A case report and review of the literature.

Purpose: To report a case of Descemet membrane endothelial keratoplasty (DMEK) for the management of post-laser in situ keratomileusis (LASIK) interface fluid syndrome (IFS) secondary to failed Descemet stripping automated endothelial keratoplasty (DSAEK) graft, and to provide a literature review on endothelial keratoplasty (EK) for this indication. Observations: A 52-year-old patient presented with LASIK interface fluid accumulation and a non-functioning primary DSAEK graft. Past ophthalmic history was relevant for: (1) phakic intraocular lens (PIOL) implantation with later refinement by LASIK; (2) combined PIOL explantation and refractive lens exchange due to accelerated endothelial cell loss (ECL); (3) primary DSAEK due to corneal decompensation.A secondary EK graft (DMEK) was performed, and the patient was prospectively followed for 6 months (M6). DMEK surgery was uneventful, without postoperative graft detachment. Corneal clearing and resolution of interface fluid accumulation occurred during the first postoperative month. Best-corrected visual acuity (BCVA) improved from 20/800 Snellen to 20/25 Snellen at 3-month follow-up, remaining stable at M6. Due to a persistent rise in intraocular pressure (IOP), the patient underwent uneventful non-penetrating deep sclerectomy 2 months after DMEK, with controlled IOP and without accelerated ECL. Conclusions and Importance: DMEK is feasible, effective, and safe in the management of IFS in cases where corneal endothelial failure plays a major role, even in complex eyes with previous EK grafts. Aggressive postoperative IOP control is warranted to decrease the risk of interface fluid recurrence and damage to the optic nerve. Studies with larger patient numbers are encouraged to ascertain the role of EK for this indication.

The Clinical Manifestation of Unilateral Acute Hydrops after Bilateral Laser In Situ Keratomileusis (LASIK)

PURPOSE: To report a case of a patient who underwent penetrating keratoplasty due to acute hydrops six years after undergoing a bilateral LASIK procedure. METHODS: A 19-year old male patient with -2.75 diopter myopia received a bilateral LASIK operation at a local clinic. Forty-seven months later, -2.00 cyl axis 130o astigmatism was induced in his left eye and additional surgery was performed to correct the LASIK-induced astigmatism. The patient was referred to our hospital 16 months after the secondary operation due to reduced visual acuity in his left eye. He was diagnosed with keratectasia and acute hydrops, and penetrating keratoplasty was performed. RESULTS: The retrospective analysis of the corneal topography prior to the LASIK surgery revealed that the inferior minus superior(I-S) value was 1.25 in the right eye and 1.3 in the left eye. At the time of the first evaluation at out hospital, a slit lamp examination showed an approximate 8 x 7.5mm sized area filled with aqueous humor between the corneal flap and residual stroma, and Descemet's membrane rupture was observed. Furthermore, the histopathological section of the patient's cornea confirmed keratocytes with myxoid degeneration and edematous change. CONCLUSIONS: In young patient, particularly those with suspicious asymptomatic keratoconus, LASIK and further enhancement surgery afterwards should be considered and approached in a cautious and deliberate manner.

A Case of Steroid Treatment on Haze after LASIK Retreatment in eye with previous PRK

PURPOSE: A corneal haze after LASIK retreatment in eye with previous PRK has not been reported in Korea. We experienced a case of myopic regression and haze after LASIK retreatment and treated it with fortified steroid eye solution. Herein we will present it. METHODS: A 38-year-old woman underwent the PRK for the correction of myopia in 1994 and the bilateral LASIK retreatment of myopic regression in January 2000. One year later, the left eye showed myopic regression and severe corneal haze but right eye was nearly emmetropia. PredForte(R) was dropped 4 times daily for 3 months, tapered, substituted with Flumetholon(R) for the next 3 months. We observed for 6 months. RESULTS: Three months later, refraction became nearly emmetropic and uncorrected visual acuity was 0.6. Corneal haze, central keratometric and pachymetric value were much decreased. It remained stable for 6 months.

The Effect of Corticosteroids on Myopic Regression after Laser in Situ Keratomileusis

PURPOSE: This study was to evaluate the effect of topical steroid treatment on eyes that showed myopic regression after LASIK. METHODS: A total of 26 patients (33 eyes) who showed myopic regression more than 1.00 diopter(D) confirmed by topography and pachymeter, were prospectively treated with 1% topical prednisolone acetate. Manifest refraction, Snellen uncorrected visual acuity and intraocular pressure(IOP) were measured before and after treatment. Topical steroids were administered every 2 hours for 3 days and 4 times a day for 11 days. Then the treatments were tapered in the eyes that showed over +0.50 D reversal of myopic regression. But it was immediately stopped in those eyes that showed no improvement or IOP increase. Pachymeter was taken in the improved group 4 weeks after the treatment. RESULTS: Fifteen eyes (45.5 %) showed over +0.50 D reversal of myopic regression(mean +/- SD +1.21 +/- 0.74 D, range: +0.50 ~ +2.75) and the uncorrected visual acuity increased (20/45 before treatment, 20/27 after treatment, p<0.01). The mean corneal thickness decreased (501.9 +/- 18.5 micrometer before treatment, 492.2 +/- 19.2 micrometer after treatment, p<0.01). Refractive effect of the steroid treatment remained stable with four of the eight eyes that could be followed up over six months. IOP was elevated in 3 eyes, but readily normalized with pressure-lowering agent. CONCLUSIONS: Topical steroid treatment for myopic regression after LASIK is partially effective and safe. It is recommendable to use topical steroid prior to performing surgical retreatment.