Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution.

PURPOSE: To analyze the short-term clinical and topographic outcomes in patients with keratoconus after corneal collagen cross-linking treatment (CXL) with dextran-free isotonic riboflavin solution. METHODS: In this retrospective case series, 26 eyes from 26 patients with keratoconus were studied. The best corrected visual acuity (BCVA) and refractive and topographic findings were analyzed at a 6-month follow-up. RESULTS: The mean BCVA (Snellen lines) values before and 1, 3, and 6 months after CXL were 0.51 ± 0.2, 0.48 ± 0.2, 0.57 ± 0.2, and 0.64 ± 0.2, respectively, and the difference between the preoperative and 6-month values was statistically significant (p=0.006). The mean spherical equivalent refraction decreased from -5.6 ± 2.4 diopters (D) preoperatively to -5.0 ± 2.1 D, and mean simulated keratometry decreased from 48.5 ± 2.5 D to 47.8 ± 2.6 D at 6 months. (p=0.145 and p=0.001, respectively). In addition, the maximum keratometry decreased progressively and significantly from the preoperative value during follow-up (p=0.003). The central and minimal corneal thicknesses, including those of the epithelium, also decreased from 442.8 ± 25.6 µm and 430.5 ± 23.9 µm preoperatively to 420.7 ± 31.8 µm and 409.3 ± 28.7 µm at the most recent follow-up (p<0.001), respectively. No intraoperative or postoperative complications were observed. CONCLUSIONS: CXL with dextran-free isotonic riboflavin solution appears to be a safe treatment alternative for keratoconus and yields sustained short-term improvements in visual acuity, keratometric readings, and corneal thickness. However, long-term results are needed to confirm these outcomes.

Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution / Resultados após seis meses de crosslinking de córnea com solução isotônica de riboflavina sem dextrano

ABSTRACT Purpose: To analyze the short-term clinical and topographic outcomes in patients with keratoconus after corneal collagen cross-linking treatment (CXL) with dextran-free isotonic riboflavin solution. Methods: In this retrospective case series, 26 eyes from 26 patients with keratoconus were studied. The best corrected visual acuity (BCVA) and refractive and topographic findings were analyzed at a 6-month follow-up. Results: The mean BCVA (Snellen lines) values before and 1, 3, and 6 months after CXL were 0.51 ± 0.2, 0.48 ± 0.2, 0.57 ± 0.2, and 0.64 ± 0.2, respectively, and the difference between the preoperative and 6-month values was statistically significant (p=0.006). The mean spherical equivalent refraction decreased from -5.6 ± 2.4 diopters (D) preoperatively to -5.0 ± 2.1 D, and mean simulated keratometry decreased from 48.5 ± 2.5 D to 47.8 ± 2.6 D at 6 months. (p=0.145 and p=0.001, respectively). In addition, the maximum keratometry decreased progressively and significantly from the preoperative value during follow-up (p=0.003). The central and minimal corneal thicknesses, including those of the epithelium, also decreased from 442.8 ± 25.6 µm and 430.5 ± 23.9 µm preoperatively to 420.7 ± 31.8 µm and 409.3 ± 28.7 µm at the most recent follow-up (p<0.001), respectively. No intraoperative or postoperative complications were observed. Conclusions: CXL with dextran-free isotonic riboflavin solution appears to be a safe treatment alternative for keratoconus and yields sustained short-term improvements in visual acuity, keratometric readings, and corneal thickness. However, long-term results are needed to confirm these outcomes.

RESUMO Objetivo: Analisar os resultados clínicos e topográficos curto prazo após crosslinking (CXL) de córnea com solução isotônica de riboflavina sem dextrano, em pacientes com ceratocone. Método: Estudamos 26 olhos de 26 pacientes com ceratocone, nesta série retrospectiva de casos. Melhor acuidade visual corrigida (BCVA), refração e achados topográficos foram analisados aos 6 meses de acompanhamento. Resultados: BCVA pré-operatória (linhas de Snellen) foi de 0,51 ± 0,2. BCVA após CXL foram de 0,48 ± 0,2, 0,57 ± 0,2 e 0,64 ± 0,2 no 1º, 3º e 6º meses, respectivamente. A diferença entre a BCVA pré-operatória e mais recente foi estatisticamente significativa (p=0,006). O equivalente esférico médio diminuiu de -5,6 ± 2,4 dioptrias (D) no pré-operatório para -5.0 ± 2.1 D e a média da ceratometria simulada diminuiu de 48,5 ± 2,5 D para 47, 8± 2,6 D aos 6 meses. (p=0,145 e p=0,001, respectivamente). A ceratometria máxima diminuiu progressivamente durante o acompanhamento com as mudanças sendo significativamente diferentes do valor pré-operatório (p=0,003). As espessuras corneanas central e mínima, diminuiram de 442,8 ± 25,6 µm e 430,5 ± 23,9 µm para 420,7 ± 31,8 µm e 409,3 ± 28,7 µm, respectivamente, na visita mais recente (p<0,001). Não foram observadas complicações intraoperatórias e pós-operatórias. Conclusões: CXL com solução de riboflavina isotônica sem dextrano parece ser uma opção segura de tratamento para o ceratocone com melhora mantida na acuidade visual, ceratometria e espessura corneana, no curto prazo. Resultados a longo prazo são necessários para confirmar estes resultados.

Unilateral Recurrent Anterior Uveitis as the Presenting Sign of Bladder Carcinoma.

A 79-year-old male patient was followed for unilateral uveitis with 3 attacks in 10 months, despite initial improvement with steroid therapy. The patient had visual acuity (VA) of counting fingers in right eye, hypopyon and vitritis with no chorioretinal lesions. The left eye was normal. The patient was evaluated for intraocular foreign body, intraocular lymphoma and associated systemic disease and malignancy. Computed tomography of the abdomen showed a mass in the bladder. Biopsy confirmed bladder carcinoma. After resection of the mass, intraocular inflammation improved completely and no attack was noted in the follow-up. In his last examination, two years after the operation, VA was light perception; seclusio pupilla and mature cataracts were seen on biomicroscopy. There was no sign of vitritis on ocular ultrasonography. Evidence is discussed that suggests a link and potential etiology between refractory uveitis with hypopyon and bladder carcinoma. This is the first case of unilateral recurrent uveitis with hypopyon as the initial presenting sign of bladder carcinoma.

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes.

PURPOSE: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. METHODS: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. RESULTS: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). CONCLUSIONS: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity.

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes / Remoção ou troca de lentes intraoculares: indicações, intervenções pós-operatórias e resultados

ABSTRACT Purpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). Conclusions: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity. .

RESUMO Objetivo: Analisar as indicações para a remoção ou troca de lentes intraoculares (IOL), que foram originalmente implantadas para a correção de afacia após a extração da catarata. Método: Todos os casos que envolveram remoção ou troca de lentes intraoculares em uma única instituição, entre janeiro de 2008 e dezembro 2014 foram analisados retrospectivamente. Resultados: No total, foram analisados 93 olhos de 93 pacientes. O intervalo de tempo médio entre o implante e a remoção das LIOs de câmara anterior (AC IOL) e de câmara posterior (PC IOL) foi 83,40 ± 83,14 meses (variando de 1 a 276 meses) e 55,14 ± 39,25 meses (variando de 1 a 168 meses), respectivamente. Ceratopatia bolhosa pseudofácica (17 olhos, 38,6%) e irite persistente (12 olhos, 27,8%) no grupo AC IOL, e deslocamento ou descentralização (30 olhos, 61,2%) e poder incorreto da IOL (nove olhos, 18,4%), no grupo PC IOL, foram as indicações mais comuns para a remoção das IOLs. A média logMAR da melhor acuidade visual corrigida (BCVA) melhorou significativamente a partir de 1,30 no pré-operatório para 0,62 no pós-operatório no grupo PC IOL (p<0,001), mas não melhorou significativamente no grupo AC IOL (p=0,186). Conclusões: A principal indicação para remoção ou troca de lentes intraoculares foi a ceratopatia bolhosa pesudofácica no grupo AC IOL e deslocamento ou descentralização no grupo PC IOL. A remoção ou troca de PC IOLs é segura e melhora a acuidade visual. .

Relationship of inferior oblique overaction to macular and subfoveal choroidal thickness.

PURPOSE: To evaluate the macular and subfoveal choroidal thickness of eyes with inferior oblique muscle overaction (IOOA) using enhanced depth imaging spectral domain optical coherence tomography (EDI SD-OCT). METHODS: The measurements of macular and subfoveal choroidal thickness obtained by EDI SD-OCT of patients with IOOA (24 patients) were compared with those of age- and sex-matched controls (25 subjects). RESULTS: There were no morphological abnormalities of the macula in patients with IOOA or in control subjects. There were no statistically significant differences in macular and subfoveal choroidal thickness between the eyes with IOOA and the eyes of the control subjects (P > 0.05). When the patients with IOOA were assigned to two distinct groups according to the degree of IOOA, the macular thickness did not differ between groups (P = 0.66), whereas subfoveal choroidal thickness measures were significantly lower in eyes with severe IOOA compared to eyes of the controls (P = 0.01). CONCLUSIONS: IOOA has no effect on the morphology and the thickness of the macula. Severe IOOA seems to be related to thinning of subfoveal choroid due to possible external mechanical effect.

Intraoperative corneal thickness monitoring during corneal collagen cross-linking with isotonic riboflavin solution with and without dextran.

PURPOSE: The aim of this study was to analyze and compare corneal thickness changes during corneal collagen cross-linking procedures performed with isoosmolar riboflavin solution with 20% dextran and without dextran in corneal ectatic diseases. METHODS: The patients in this study were analyzed in 2 groups: group 1 receiving riboflavin solution containing 20% dextran and group 2 receiving dextran-free riboflavin solution. Corneal thickness measurements were obtained with ultrasonic pachymetry at 6 different time points: preoperatively and at 0, 15, 30, 45, and 60 minutes after epithelial removal and initiation of ultraviolet A irradiation. RESULTS: Twenty-seven eyes of 27 patients with progressive keratoconus were included in the study. In group 1 (n = 13), the mean preoperative thinnest pachymetric readings were 469.3 ± 8.5 µm, which decreased to 423.8 ± 8.9 µm after deepithelization and further decreased to 385.9 ± 10.9 µm at 15 minutes. The corneal thickness assumed a steady course at the 30-, 45-, and 60-minute measurements (378.9 ± 9.8 µm, 384.5 ± 10.5 µm, and 396.7 ± 9.4 µm, respectively). The initial change was statistically significant (P < 0.01). In group 2 (n = 14), the corneal thickness decreased from 459.4 ± 3.8 µm to 414.7 ± 2.6 µm with deepithelization, after which it increased steadily with the initiation of the dextran-free riboflavin solution. The final measurement in group 2 was 474.1 ± 9.4 µm; the increase at each time point was statistically significant when compared with the previous measurement (P < 0.01). CONCLUSIONS: Using isoosmolar riboflavin solution without dextran causes a steady increase in the corneal thickness during the cross-linking procedure, as opposed to riboflavin with dextran. This result might be beneficial in broadening the spectrum of cross-linking indications in patients with thin corneas.