Pentacam characterization of corneas with Fuchs dystrophy treated with Descemet membrane endothelial keratoplasty.

PURPOSE: To characterize central corneal thickness, curvature, and posterior surface elevation in eyes with Fuchs dystrophy that underwent Descemet membrane endothelial keratoplasty (DMEK) for endothelial decompensation and to compare these characteristics with those in normal eyes. METHODS: Pre- and postoperative corneal tomography was prospectively evaluated using Pentacam (Oculus Optikgeräte GmbH) imaging on 29 eyes with Fuchs dystrophy treated with DMEK. Results were compared with data from a separate cohort of 198 normal eyes. RESULTS: In the Fuchs cohort, the mean preoperative central corneal thickness was 656 µm (range: 574 to 731 µm). This significantly exceeded the mean thickness of 542 µm in the normal cohort (range: 439 to 611 µm, P<.0001) although the cohort thickness ranges overlapped. One month after DMEK, mean central corneal thickness decreased significantly to 539 µm (range: 465 to 669 µm, P<.0001) with no further significant decrease between 1 and 3 months after DMEK (mean difference = -4 µm, P=.39). In the Fuchs cohort, keratometry (average Sim K and delta K) did not change significantly after DMEK (P=.41 and P=.44, respectively); pre- and postoperative values were comparable to those in the normal cohort. The mean forward displacement of the posterior surface increased by 69 µm 1 month after DMEK (P<.0001) without further significant change between 1 and 3 months. CONCLUSIONS: After DMEK, central corneal thickness in the Fuchs dystrophy cohort decreased significantly and the posterior corneal surface displaced forward, without significant change in anterior keratometric values or keratometric astigmatism. The preoperative central corneal thickness range in eyes with confluent central guttata overlapped the range in normal corneas.

Sinonasal adenoid cystic carcinoma presenting as an orbital mass.

A 61-year-old man with a history of sinus polyposis and prior sinus surgery presented with left-sided retrobulbar pain and headache. He was found to have left-sided proptosis, and imaging studies showed a large left medial orbital soft-tissue mass. Incisional biopsy revealed adenoid cystic carcinoma. Further evaluation revealed extensive sinonasal adenoid cystic carcinoma. The patient underwent en bloc maxillectomy with orbital exenteration and partial rhinectomy, followed by radiation therapy. The medial orbit is an unusual location for adenoid cystic carcinoma, which the authors believe was a secondary manifestation due to perineural spread from the sinuses via the ethmoidal nerves. Adenoid cystic carcinoma should be included in the differential diagnosis of tumors of the medial orbit, especially if there is a history of sinonasal disease.

Resident laser in situ keratomileusis surgical training in United States residency programs.

To determine current trends in resident laser in situ keratomileusis (LASIK) training in the United States, a comprehensive survey was sent to the residency coordinator, chairman, or refractive surgery director of all 113 ophthalmology training programs in the U.S. accredited by the Accreditation Council for Graduate Medical Education. The response rate was 64%. Of the respondents, 54% were from programs in which residents performed LASIK surgery, typically as third-year residents; residents in these programs performed a mean of 4 LASIK surgeries (range 1 to 10 surgeries) during residency. The Visx Star was the most commonly used excimer laser platform and the Hansatome the most commonly used microkeratome. Most programs had 1 attending physician teaching the residents refractive surgery, which was typically performed at the main residency facility. Most programs had significant discounted pricing (>50%) for resident-performed LASIK.

Comparison of Proview phosphene tonometry with Goldmann applanation tonometry.

BACKGROUND: To compare intraocular pressures obtained using a handheld pressure phosphene tonometer (PPT) (Proview, Bausch & Lomb Pharmaceuticals, Inc., Tampa, Fla.) with Goldmann applanation tonometry. METHODS: Comparative case series of 30 randomly selected patients. RESULTS: The readings obtained with the pressure phosphene tonometer display a higher mean and a larger standard deviation than those obtained with the Goldmann applanation tonometer (GAT). Differences between PPT and GAT readings tended to decrease as a function of increased Goldmann levels. The relation of Proview and Goldmann readings (r = 0.32) and the scatterplot were not consistent with the hypothesis that the 2 methods are equivalent. INTERPRETATION: Our results indicate that the pressure phosphene-type handheld tonometry method, which does not appear to provide an accurate and consistent measure of intraocular pressure, is substantially less reliable than the Goldmann method.