Long-term graft survival in patients with Down syndrome after penetrating keratoplasty.

PURPOSE: To determine graft survival and long-term visual outcome after penetrating keratoplasty (PK) for keratoconus in patients with Down syndrome. METHODS: The records of all patients with Down syndrome who received PK by the same provider were reviewed. A retrospective analysis was performed to determine long-term graft survival, incidence of graft failure, and complication rate. RESULTS: Twenty-one PKs were performed on 18 eyes of 13 patients with Down syndrome with keratoconus. Three repeat PKs were performed for secondary graft failure. All 18 eyes had clear grafts at the most recent examination. Follow-up ranged from 4 to 88 months, with a mean of 34.9 months. The average age of patients was 42 years, with a range of 20 to 63 years. Preoperative visual acuity ranged from 20/160 to count fingers. Postoperatively, visual acuity was objectively measurable in 12 eyes of 8 patients and ranged from 20/30 to 20/200, with a mean of 20/60. Broken sutures and difficulties with unsedated suture removal complicated postoperative care in some patients. CONCLUSION: Clear grafts and improvements in visual acuity can be obtained after PK in patients with Down syndrome, but consideration must be given to careful postoperative care by health care providers and home support personnel.

Dominant familial congenital entropion with tarsal hypoplasia and atrichosis.

BACKGROUND: Congenital entropion and atrichosis of the lower eyelids associated with tarsal hypoplasia is a rare condition, with isolated reports in the literature and without previous pathologic examination. METHODS: Case report. A father and son with mild entropion, lower eyelash atrichosis, and tarsal hypoplasia are described. A family pedigree demonstrates autosomal dominant inheritance. RESULTS: Histopathology from an entropion repair shows rudimentary tarsus and Meibomian glands consistent with hypoplasia of the tarsus. CONCLUSIONS: Isolated congenital entropion may occur in association with atrichosis of the lower eyelashes and hypoplasia of the tarsus as an isolated anomaly. The condition may be inherited as an autosomal dominant trait and appears to be well tolerated.

Warm balanced salt solution for clearing tear film precipitation during cataract surgery.

Adequate anterior segment visualization during cataract surgery can be hindered when excessive tear film secretions precipitate on the corneal surface before the initial corneal incision is made. In most cases, room-temperature balanced salt solution applied to the corneal surface clears the debris. However, in cases in which tear film precipitates persist after the use of room-temperature balanced salt solution, the application of warm balanced salt solution can provide rapid and sustained dispersion of the precipitates. We present our experience using this technique.

Analysis of anterior and posterior corneal curvature changes using Orbscan technology in radial keratotomy eyes exposed to hypoxia.

PURPOSE: To study the changes in anterior and posterior corneal curvatures in radial keratotomy (RK) and normal eyes exposed to hypoxia using Orbscan (Bausch & Lomb) technology. SETTING: Department of Ophthalmology, Madigan Army Medical Center, Tacoma, Washington, USA. METHODS: At sea level, 11 RK subjects and 10 control subjects were exposed to ocular surface hypoxia in 1 eye by filtering humidified, compressed 100% nitrogen (0% oxygen) through an airtight goggle system for 2 hours. The contralateral eye was exposed to humidified, compressed air (21% oxygen) simultaneously through the airtight goggle system. Orbscan analysis was performed in each subject before and immediately after gas exposure. This analysis included measurement of the anterior axial and posterior axial corneal curvatures as well as corneal pachymetry. RESULTS: In the RK eyes exposed to 100% nitrogen gas, there was a statistically significant flattening in the anterior axial corneal curvature (P = .0012) and in the posterior axial corneal curvature (P = .0067). Radial keratotomy and control eyes exposed to air and control eyes exposed to 100% nitrogen gas demonstrated no statistically significant change in the anterior axial or posterior axial corneal curvature. CONCLUSIONS: Corneal hypoxia induced a statistically significant flattening in the anterior axial and posterior axial corneal curvatures in eyes that had had RK. There was no significant change in these curvatures in RK eyes exposed to air and in control eyes exposed to air or 100% nitrogen gas.