Bowman Layer Transplantation With Stromal Inclusion Using Femtosecond Laser: 3-year Results.

PURPOSE: The aim of this study was to evaluate the 3-year clinical results of Bowman layer with stromal inclusion (Bowman layer) transplantation using femtosecond laser for patients with advanced keratoconus. METHODS: This single-center retrospective study included 7 eyes of 7 patients diagnosed with progressive keratoconus who underwent Bowman layer transplantation with stromal inclusion between 2018 and 2020. Follow-up was carried out from the date of surgery until 36 months later. Bowman layer grafts were positioned into a mid-stromal pocket performed by a femtosecond laser and patients were evaluated up to 3 years after surgery. RESULTS: Corneal flattening of 5.49 D (P = 0.0020) in Kmax was observed, increased in corneal pachymetry, and an improvement best-corrected visual acuity measured in logarithm of minimum angle of resolution (LogMAR) from 0.89 to 0.60 and tolerance to contact lens from 42% of the patients to 100% of them. Stabilization of the cornea was achieved in 100% with no further progression of the keratoconus; all surgical procedures were uneventful, and no complications were observed during the 3 years of follow-up. CONCLUSIONS: Bowman layer transplantation with stromal inclusion flattened the cornea improving best-corrected visual acuity and contact lens tolerance and stabilized keratoconus in 100% of the patients during 3 years of follow-up and may be a feasible option in patients with advanced and progressive KC to delay or avoid the need for PK or DALK.

Boston Keratoprosthesis type 1 (KPro) without contact lens wearing in end-stage corneal disease: The APEC experience.

PURPOSE: To report the visual outcomes and survival analysis of keratoprosthesis without contact lens wearing in a tertiary eye care hospital in Mexico City, Asociación Para Evitar La Ceguera (APEC, Coyoacán, México). DESIGN: Retrospective cohort with survival analysis. PARTICIPANTS: Twenty-three eyes (22 patients) received KPro type 1 between 2015 and 2020 with a follow-up time of three years. METHODS: We included analyzed data about past medical history, preoperative diagnosis, best-spectacle visual acuity (BSCVA), postoperative complications and retention rate. Univariate, bivariate and survival analysis were performed and reported. RESULTS: The mean age was 58 ± 13.5 years (SD). 60.86% were male patients (14 eyes). Twelve-eyes (52%) achieved a BSCVA of 20/200 or better in the first and second year of follow-up. At 3 years, only 35% achieved 20/200 or better (BSCVA). Retention rate of Boston type 1 KPro was 87% (20 eyes) at 3 years follow-up. The most common complication was retroprosthetic membrane (RPM) which occurred in 9 eyes (39.1%), followed by corneal melting in 7 eyes (30.4%). CONCLUSIONS: We report the results of a retrospective cohort of twenty-three eyes (22 patients) who were implanted with a Boston type 1 KPro without contact lens wearing to treat corneal blindness. BSCVA improved significantly in most patients achieving 20/200 or better at the 2-year follow-up. Retention rate was 87%, with the presence of RPM as the most common complication.

Pars plana vitrectomy and therapeutic keratoplasty in endophthalmitis and infectious keratitis.

PURPOSE: To describe the anatomical and functional outcomes of patients with infectious keratitis (IK) and secondary endophthalmitis who underwent penetrating keratoplasty (PK) after pars plana vitrectomy (PPV) assisted by temporary keratoprosthesis (TKP). METHODS: An observational retrospective case series was performed. Data were collected from January 2013 to July 2020. Patients over 18 years old with a clinical and microbiological diagnosis of IK, and clinical, ultrasonographic, and or microbiological diagnosis of endophthalmitis were included. Anatomical success was defined as infection resolution with preservation of the ocular globe integrity. No change or improvement of best-corrected visual acuity (VA) at the last follow-up was considered as a functional success. RESULTS: A total of 32 eyes of 32 patients were analyzed. The anatomic success was obtained in 87.5% eyes in which the infection was eradicated. The 63% patients maintained or improved their best-corrected VA, 37.5% ended up with hand motion VA. CONCLUSIONS: Our results suggest that PPV assisted by TKP followed by PKP can be a good approach for treating patients with endophthalmitis secondary to IK while allowing further visual improvement after an optical PK. Further prospective studies need to be done to evaluate final visual rehabilitation of these patients.

Bilateral Corneal Ectasia 3 Years After Small Incision Lenticule Extraction in a Borderline Case.

PURPOSE: The purpose of this study was to report a case of bilateral ectasia 3 years after small incision lenticule extraction (SMILE) in a patient with normal preoperative topography of the right eye and abnormal topography of the left eye. METHODS: This study was a case report. RESULTS: A 22-year-old man developed bilateral corneal ectasia after SMILE. The preoperative corneal topography of the right eye was unremarkable, with a minimum corneal thickness of 511 µm in the right eye, and the abnormal corneal topography of the left eye revealed a risk factor for developing ectasia, with a minimum corneal thickness of 514 µm in the left eye. The refractive error was -4.50 to 3.50 × 10 degrees in his right eye and -4.25 to 3.50 × 0 degrees in his left eye with a best-corrected visual acuity of 20/20. An uncomplicated SMILE was performed; after his last follow-up visit at 1 month, the patient was lost to follow-up for 3 years. After that time, he presented with visual loss with left predominance. Bilateral ectasia was diagnosed through corneal topography, and crosslinking was performed in both eyes. CONCLUSIONS: There are a very few reports of corneal ectasia after SMILE with normal preoperative topography.

Primary surgical options for acute corneal hydrops: A review.

Acute corneal hydrops usually resolves alone or with medical therapy along the first 4-6 weeks. However, depending on the severity of the corneal edema or the size of the Descemet break, self-healing might be difficult. Years ago, those patients had no more options than corneal transplantation, but surgical alternatives are on the rise in this century. These surgeries are becoming more popular with a variety of techniques relegating penetrating keratoplasty to a residual role. These techniques aim to accelerate corneal healing, reduce the edema, improve visual acuity and prevent from severe complications that may appear if corneal hydrops is not treated rapidly. Feasibility and safety are the favorable aspects of these techniques since the complications rates described remain low. In this review, we emphasize the recently published studies that describe both the techniques and their results.

Intrastromal Allogeneic Inclusions for the Management of Keratoconus: A Review of Current Literature.

ABSTRACT: A new therapeutic alternative has been developed in the past 6 years to treat severe keratoconus in young patients. Those patients had only corneal transplantation as an option, but now a variety of surgical alternatives in the form of allogeneic corneal inclusions have bloomed and are becoming more popular. Although Bowman layer transplantation is the most studied technique, recent studies have described different options with very promising preliminary results. Mostly all the techniques described improve corneal curvature, visual acuity, pachymetry, contact lens tolerance, and foremost, manage to avoid or postpone corneal transplantation. Very few complications have been described so far, which makes these techniques not only feasible but also safe. Herein, we focus on reviewing recently published studies describing these techniques and their first results.

In Vivo Confocal Microscopy Findings in Bowman Layer Transplantation.

PURPOSE: To report the in vivo confocal microscopy (IVCM) findings of a case who underwent femtosecond laser-assisted Bowman layer transplantation (BLT). METHODS: This is a case report. RESULTS: In a 25-year-old man with previous diagnosis of keratoconus in whom a BLT was performed using the femtosecond laser-assisted technique, IVCM (Confoscan 4; Fortune Technologies, Vigonza, Italy) was performed 3 months after surgery, obtaining a sequence of 4 digitalized images of the total thickness of the cornea, from the epithelium to the endothelium, and then backward. The images were analyzed with the Navis v. 3.5.0. system (NIDEK, Multi-Instrument Diagnostic System, Japan). In the anterior stroma, before arriving to the graft interphase, activated keratocytes could be observed with higher reflectivity. In this first image of the anterior interphase, a homogenous hyporreflective image could be observed. In the interior of the graft, no keratocytes were found and some hyperreflective particles were present. In addition to the anterior, the posterior interphase presented bright particles. CONCLUSIONS: This is the first report that documents a BLT using IVCM.

Visual and Anatomic Results After Sole Full-Thickness Sutures for Acute Corneal Hydrops.

PURPOSE: To determine whether sole full-thickness corneal sutures are a feasible treatment for acute corneal hydrops, and if so, report the anatomic and visual results of this technique. METHODS: A retrospective case series was carried out in 17 patients, all of whom received sole full-thickness sutures as a treatment for corneal hydrops. RESULTS: The included patients reported symptom commencement a median of 15 days before the surgical intervention. The patients' median preoperative corneal pachymetry was 1235 µm, whereas 1 month after the surgery, the median corneal thickness was 830 µm, and after 3 months, it was 502 µm (P < 0001). Preoperative best corrected visual acuity (BCVA) was 1.40 LogMAR and a final postsurgical BCVA of 1.00 LogMAR after 3 months of the follow-up (P < 0001). Deep neovascularization was present in 3 patients (17.6%); none of the patients developed cataract formations or pupillary blocks. CONCLUSIONS: Given the improvement of the corneal pachymetry and the BCVA, sole full-thickness sutures seem to be a feasible surgical option to treat severe acute corneal hydrops.