Vernal shield ulcers treated with frequently installed topical cyclosporine 0.05% eyedrops.

PURPOSE: To report on the beneficial results of an intense regimen of 0.05% cyclosporine eye drops, eight times a day in patients with therapy resistant vernal shield ulcers. METHODS: Case cohort of four eyes of three male children with vernal keratoconjunctivitis complicated by shield ulcers, who were treated with frequent cyclosporine 0.05% eye drops and observed for up to 5 years. RESULTS: Quick resolution of the shield ulcers and complete re-epithelialization within 14-25 days was observed after adding intensive treatment with cyclosporine 0.05% to regular anti-inflammatory, histamine blocking, and surgical therapy. In one patient, additional scraping of the bottom of the ulcer was needed. CONCLUSIONS: In patients with vernal shield ulcers, frequent installation of low-concentration cyclosporine eye drops seems to have a promising therapeutical value.

Opacification of the Intraocular Lens After Descemet Stripping Endothelial Keratoplasty.

PURPOSE: To report the incidence of opacification of the intraocular lens (IOL) after Descemet stripping endothelial keratoplasty (DSEK) in an academic ophthalmology clinic. METHODS: In this retrospective case series, all patients who underwent DSEK between 2003 and 2013 were included. In 2008, the first patient presented with reduced vision as a result of opacification of the IOL in our clinic. The period between DSEK surgery and diagnosis of IOL opacification, Snellen corrected distance visual acuity before and after the appearance of IOL opacification, IOL specifications, and incidence of IOL exchange were assessed. RESULTS: A total of 160 eyes were operated on. Opacification was seen in 8 eyes (5%) and was diagnosed between 4 and 24 months after DSEK (mean, 9.6; SD, 6.3; range, 4-24 months). The mean Snellen corrected distance visual acuity was 0.6 (SD, 0.2; range, 0.2-0.8) before opacification and 0.3 (SD, 0.2; range, 0.02-0.6) after opacification of the IOL occurred. The IOL material was hydrophilic acrylic in all patients. In 4 eyes, IOL exchange was performed. CONCLUSIONS: Opacification of the IOL can be a vision-threatening late complication after DSEK and was seen in 8 of 160 eyes.

Indications for and outcomes of tertiary referrals in refractive surgery.

PURPOSE: To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. METHODS: A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention. RESULTS: One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye. CONCLUSIONS: No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedures.