Excimer laser phototherapeutic keratectomy for the treatment of silicone oil-induced band-shaped keratopathy.

PURPOSE: To study the efficacy of excimer laser phototherapeutic keratectomy (PTK) for the treatment of band-shaped keratopathy (BSK). METHODS: A retrospective analysis of case records of 20 eyes of 20 patients with silicone oil-induced BSK and significant media haze that underwent PTK was conducted. Improvement in corneal clarity and best-corrected visual acuity (BCVA) was assessed at 6 weeks postoperatively. RESULTS: The mean ablation depth was 62.63±23.82 µm (range 25 to 100 µm). Postoperative course was uneventful, and the mean time for healing of the epithelial defect was 4.25±2.43 days. All the eyes showed significant improvement in corneal clarity at 6 weeks postoperatively. The mean score of corneal clarity increased from 1.15±0.74 preoperatively to 3.35±0.49 at 6 weeks postoperatively (P<0.001). At postoperative 6 weeks, 90% (18 eyes) showed an improvement in BCVA of 2 or more lines, whereas the BCVA remained unchanged in two eyes (10%). There was a hyperopic shift postoperatively with a mean shift of spherical equivalent of 2.23±2.08 D. At the end of the last follow-up (mean: 16.75±4.2 months; range 11-24 months), two eyes with silicone oil in the vitreous chamber and with inferior peripheral and shallow retinal detachment showed recurrence of BSK for which retreatment with PTK was given. CONCLUSIONS: Phototherapeutic keratectomy is an effective option for the treatment of silicone oil-induced BSK with significant improvement in corneal clarity. However, the gain in visual acuity depends on the coincident posterior segment pathologic condition. Further, in eyes with retained silicone oil, there is a risk of recurrence of BSK for which retreatment may be required.

Congenital horizontal tarsal kink with microphthalmos corrected by intermarginal suture tarsorrhaphy.

Congenital horizontal tarsal kink is extremely rare. Only one case of associated microphthalmos has been reported. Various surgical techniques have been described with successful results. Few reported cases have been managed with intermarginal suture tarsorrhaphy. The current case is probably the third patient with severe tarsal kink to be managed with this simple technique.

Documentation of capsular opacification and incomplete cell migration barrier formation by ThinOptX IOL using Miyake-Apple view.

The purpose of this study was to evaluate the in situ relationship of ThinOptX intraocular lens (IOL) in a cadaveric donor eye with posterior capsular opacification (PCO), following report of high PCO rates with this IOL. A cadaveric donor eye implanted with ThinOptX IOL and received at our eye bank was fixed in 10% formalin after retrieval of corneoscleral button. The globe was sectioned at equator and evaluated from the posterior (Miyake-Apple) view. Complete iridectomy was performed and IOL evaluated from the anterior (surgeon's) view. The IOL was well centered in the bag. A thick (Grade 4) Sommering ring was seen with centripetal extension across the IOL edge margin. The anterior capsule showed fibrosis and distortion of the capsulorrhexis margin. It seems from our findings that in some cases, the edge of the ThinOptX IOL may not provide an adequate barrier to epithelial cell migration and PCO formation. This can have clinical implications which need evaluation in large clinical and histopathological studies.

Endothelial decompensation following epithelial LASIK with loss of epithelial flap.

PURPOSE: To report a case that showed endothelial decompensation after epithelial LASIK (epi-LASIK). METHODS: A 23-year-old woman underwent epi-LASIK surgery to correct refractive error of -4.00 -3.00 x 165 degrees in the right eye and -2.50 -2.00 x 15 degrees in the left eye. Preoperatively, the specular count was 2896 cells/mm2 in the right eye and 3046 cells/mm2 in the left eye. Central corneal thickness (CCT) was 490 microm and 493 microm in the right and left eyes, respectively. RESULTS: Examination on the first postoperative day revealed diffuse corneal edema with radiating Descemet's folds in the right eye with best spectacle-corrected visual acuity of 20/80. Central corneal thickness was 493 microm and 373 microm in the right and left eyes, respectively, 1 week after surgery. Corneal edema resolved over a period of 3 weeks with healing of the epithelial defect. Endothelial cell count 3 weeks after surgery was 1310 cells/mm2 in the right eye. CONCLUSIONS: Epi-LASIK can cause significant endothelial cell loss with development of corneal edema.

Treatment of acute corneal hydrops with intracameral C3F8 in a patient of pellucid marginal degeneration with keratoglobus.

We report the use of perfluoropropane (C(3)F(8)) gas for the treatment of acute hydrops with intrastromal cleft in a case of pellucid marginal degeneration with keratoglobus. Acute hydrops in a 36-year-old man with pellucid marginal degeneration with keratoglobus was treated with intracameral injection of 0.3 mL isoexpansile C(3)F(8) (14%). Reduction in corneal haze was seen beginning from the third postoperative day. Significant clearing had taken place by the end of the second week with the closure of intrastromal cleft. Best corrected visual acuity improved from finger counting at 1 foot preoperatively to 6/18 after 2 weeks. There was no postoperative rise in intraocular pressure or cataract formation. Intracameral injection of C(3)F(8) may possibly be a viable treatment option for acute hydrops in a case of corneal ectasia. Larger studies are required to clarify the role of intracameral gas injection in the treatment of acute hydrops in corneal ectasia.