Posterior-chamber phakic implantable collamer lenses with a central port: a review.

We aimed to summarize the outcomes reported following the implantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc) for myopia correction. A literature search in PubMed, Web of Science and Scopus was carried out to identify publications reporting clinical outcomes of patients who were implanted with the V4c ICL model and had a follow-up period of at least 6 months. A total of 35 clinical studies published between 2012 and 2020 were included in the present review. A comprehensive analysis of the available data was performed, focusing on visual and refractive outcomes at different time-points post-surgery. In addition, adverse events and other parameters such as endothelial cell density, intraocular pressure and vault measurements-which were evaluated in some of the studies-were also compared. This review encompassed a total of 2904 eyes. The outcomes reported in this review lead us to conclude that ICL V4c implantation for myopia correction is a safe and efficient procedure, with stable visual and refractive outcomes and low adverse event rates. The patient's anterior segment should be thoroughly characterized, and the ICL parameters should be carefully selected so as to achieve good outcomes and avoid complications.

Agreement of white-to-white measurements with swept-source OCT, Scheimpflug and color LED devices.

PURPOSE: To assess the interchangeability of different devices for measuring white-to-white (WTW) distance. METHODS: WTW distance was measured in 53 eyes of 53 patients using Anterion swept-source optical coherence topographer (SS-OCT), IOLMaster 700 SS-OCT, Pentacam HR Scheimpflug and Cassini color LED. Statistical analysis was done by means of the Friedman test and the post hoc Tukey test. The Bland-Altman analysis was applied to carry out pairwise comparisons with the average difference, 95% confidence interval of the average difference and limits of agreement 95% (LoA). RESULTS: WTW values obtained by the Anterion, IOLMaster 700, Pentacam HR and Cassini were: 11.84 ± 0.41 mm, 11.96 ± 0.41 mm, 11.68 ± 0.38 mm and 12.65 ± 0.52 mm, respectively. Statistically significant differences were found in all pairwise comparison (p < 0.001). The lowest mean difference was found between the Anterion and IOLMaster 700 (- 0.11 mm) and the highest between the Pentacam HR and Cassini (- 0.96 mm). The widest LoA ranges were those that compared any device with the Cassini. LoA ranges when the other three devices were compared among them were similar: Anterion versus IOLMaster 700, Anterion versus Pentacam HR and IOLMaster versus Pentacam HR (about 0.2 mm). CONCLUSIONS: Our results show that there were statistically significant differences in WTW measurement among the four devices, but under a clinical point of view, we believe that Anterion and IOLMaster 700 may be considered interchangeable and so Anterion and Pentacam HR, however, IOLMaster 700 and Pentacam HR may not and neither is Cassini with any of the other three devices.

Posterior-Chamber Phakic Intraocular Lens Implantation in Patients over 40 Years of Age.

PURPOSE: To assess the efficacy, safety, and predictability of the Visian Implantable Collamer Lens (ICL) model having a central port in patients over 40 years of age. METHODS: This study included 33 eyes from 21 patients who underwent V4c ICL implantation for the correction of myopia and myopic astigmatism. We assessed uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events occurring over a 1-year period. RESULTS: Mean age of the patients at the time of implantation was 43.52 ± 4.49 years (range: 40 to 56 years). Efficacy and safety indexes were 1 and 1.09, respectively. Surgical outcomes for CDVA were as follows: no eye lost any lines, 19 eyes (57.58%) showed no CDVA changes, 7 eyes (21.21%) gained 1 line, 4 eyes (12.12%) gained 2 lines, and 3 eyes (9.09%) gained ≥3 lines. Mean postoperative spherical equivalent (SE) was -0.09 ± 0.47 D. A total of 29 eyes (87.8%) were within ±0.50 D and 31 eyes (93.9%) were within ±1.00 D of the desired SE. At 1-year, mean IOP was 15.27 ± 3.03 mmHg (range: 9 to 20 mmHg, p=0.12 pre vs. post) and mean ECD was 2516 ± 234 cells/mm2 (p=0.29 pre vs. post). Mean postoperative vault was 320 ± 136 µm, with 201-300 µm being the most prevalent vault range for 9 eyes (31.03%). None of the eyes showed a vault >701 µm. There were neither intraoperative nor postoperative complications; in fact, all ICL implantation procedures were uneventful. CONCLUSIONS: Our study's findings support the use of this lens in patients over 40 years of age. A long follow-up period is advisable to monitor ICL position relative to the crystalline lens.

Alport Syndrome and Femtosecond Laser-assisted Cataract Surgery.

We report the surgical management of a patient with bilateral anterior lenticonus due to Alport syndrome using femtosecond laser-assisted cataract surgery (FLACS) and the Optiwave Refractive Analysis (ORA) system. A 38-year-old man with Alport syndrome presented to our department with visual loss due to anterior lenticonus in both eyes. Adjustments during bilateral FLACS were performed with the software's calipers to manually delineate the anterior capsulotomy. Multifocal toric intraocular lenses (IOLs) were selected and placed in the posterior chamber with the aid of intraoperative aberrometry. The intended postoperative positioning parameters for the IOL as well as the planned visual acuity and refraction were achieved. The implementation of FLACS and intraoperative wavefront aberrometry is a safe and useful surgical approach for the management of cataract in challenging cases such as patients with anterior lenticonus due to Alport syndrome.

Femtosecond laser-assisted capsulotomy for treatment of bilateral anterior capsule contraction.

A 51-year-old woman developed severe fibrosis and occlusion of the visual axis in 1 eye, maintaining a pinhole aperture in the fellow eye, 2 months after uneventful cataract surgery and implantation of a hydrophilic trifocal intraocular lens in the capsular bag. She had not exhibited any risk factor for anterior capsule contraction preoperatively. Femtosecond laser-assisted capsulotomy with a fluid-filled interface system was used to perform a simultaneous anterior capsulotomy in both eyes. Preoperative calculations of the incision depth of the capsulotomy were performed using optical coherence tomography (OCT) and adjusted intraoperatively with the OCT system of the femtosecond laser. The energy level used in the first eye was increased for the second eye (4 µJ to 6 µJ) because of severe capsulotomy tags that had to be cut with scissors. Despite the increase in energy, a free-floating capsulotomy could not be achieved in the second eye.

Effect of the Femtosecond Laser on an Intracorneal Inlay for Surgical Compensation of Presbyopia during Cataract Surgery: Scanning Electron Microscope Imaging.

PURPOSE: To investigate the effect of the femtosecond laser-assisted cataract surgery (FLACS) on porcine eyes implanted with a Kamra corneal inlay and to describe how the inlay may change the effect of the femtosecond laser on the lens. METHODS: FLACS was performed on six porcine eyes and a Kamra corneal inlay had been implanted, exploring the lens under the surgical microscope. Another Kamra corneal inlay was attached to the upper part of the transparent hemisphere used for calibration of the femtosecond laser. Capsulorhexis, arcuate incisions, and phacofragmentation were carried out. The Kamra corneal inlay was compared with a nontreated one using a scanning electron microscope (SEM), and the hemisphere was analyzed with a surgical microscope. RESULTS: Capsulorhexis and phacofragmentation were completed in all the porcine eyes, although accuracy to determine the exact effect on the lens was not possible to achieve. The effect of the femtosecond laser on the PMMA hemisphere through the Kamra corneal inlay showed the capsulorhexis was placed outside the outer margin of the inlay and a sharply sculpted fragmentation pattern with a three-dimensional (donut-shaped) annulus untreated beneath it. SEM images of the nontreated and the treated inlays were comparable. No ultrastructural changes were found in the treated Kamra corneal inlay. CONCLUSIONS: FLACS can be performed with a Kamra corneal inlay for surgical compensation of presbyopia without the risk of damaging the inlay. The Kamra corneal inlay acts as a screen that avoids the laser to reach the areas beneath its shadow, but not the exposed areas of the lens.

Porcine Model to Evaluate Real-Time Intraocular Pressure During Femtosecond Laser Cataract Surgery.

PURPOSE: To investigate the changes in intraocular pressure (IOP) in porcine eyes during femtosecond laser-assisted cataract surgery using a liquid-optic interface system. MATERIALS AND METHODS: Femtosecond laser cataract surgery with the Catalys™ was performed on freshly enucleated porcine eyes in Oftalvist Moncloa, Madrid, Spain. Capsulorhexis and lens fragmentation were completed in all the eyes without complications. IOP was measured with a reusable blood pressure transducer connected by direct cannulation to the anterior chamber, recording data before suction (basal), at the beginning of the suction phase, every five seconds during femtosecond procedure and after the removal of the suction ring from the eye. RESULTS: Nine porcine eyes were used in this study. Basal IOP before suction was 5.67 ± 2.39 mmHg, rising to 20.33 ± 4.18 mmHg at the beginning of the suction phase (p < 0.001). During femtosecond procedure, pressure reached a value of 19.74 ± 4.31 mmHg, remaining stable during the entire process. The IOP recorded prior to removal of the suction ring was 21.00 ± 6.93 mmHg, returning to basal values in all the eyes after the suction ring was removed, with no statistical differences between basal and post-suction IOPs. Total femtosecond procedure time was 125.9 ± 15.9 s. CONCLUSIONS: Real-time IOP can be measured during surgery using a transducer connected to the anterior chamber. The results showed a significant increase in IOP during the procedure due to the pressure exerted by the suction ring but not by the effect of the femtosecond laser.

Corneal erosion and Kindler syndrome.

PURPOSE: To describe a very common corneal pathology in a patient with Kindler syndrome. CASE REPORT: We report the case of a 21-year-old woman, who presented to the Ophthalmology Department as an emergency presentation because of ocular pain in the left eye that radiated to other areas of the face and neck. After an exhaustive clinical interview, it was determined that the patient had a rare disease (Kindler syndrome). Ophthalmologic examination revealed corneal erosion on the left eye. No other significant conditions were found. After the application of conventional treatment, the corneal integrity was completely restored. CONCLUSIONS: We describe a very rare syndrome. Although conventional treatment restored corneal integrity, it is important to remember that ocular signs and symptoms are often associated with systemic pathologies.

Relationship between patient age and refractive index of the corneal stroma during refractive surgery assisted by femtosecond laser flap creation.

PURPOSE: To measure the refractive index (RI) of the human corneal stroma in vivo using an objective Abbé refractometer (VCH-1) and to determine if RI of the stroma is related to age. METHODS: VCH-1 was used to measure RI at the central anterior stroma immediately after lifting the flap in neophyte patients preselected for laser in situ keratomileusis. Surgical procedures continued as preplanned after measuring the RI, and in binocular cases, measurements were taken from the right eye only. Corneal flaps were created using a femtosecond laser system. RESULTS: Mean RI (±SD, range) and age (±SD, range) values were 1.373 (±0.006, 1.358-1.385) and 36.55 (±12.26, 18-74). A significant linear correlation was found between age and RI. Least squares regression lines equating RI with age (x, years) were of the form: RI = 1.36911 + 0.000096x (r = +0.195; n = 115; P = 0.037). Mean RI (± SD) in the 2 age groups separated by the median age (≤34 and ≥35) were 1.371 (±0.007; n = 57) and 1.374 (±0.005; n = 58). The difference was statistically significant (P = 0.018). CONCLUSIONS: RI of the anterior stroma in vivo tends to be increased in older patients when the corneal flap is created using a femtosecond laser device.

The influence of age on the refractive index of the human corneal stroma resected using a mechanical microkeratome.

PURPOSE: To measure the refractive index (RI) of the human corneal stroma in vivo using an objective Abbé refractometer (VCH-1) and to determine if RI of the stroma is related to age. METHODS: The VCH-1 was calibrated against a standard subjective Abbé refractometer using 7 randomly selected turbid semiliquid media. VCH-1 was used to measure RI at the central midstroma immediately after lifting the flap in neophyte patients preselected for laser-assisted in situ keratomileusis. Surgical procedures continued as preplanned after measuring the RI; in binocular cases, measurements were taken from the right eye only. Flaps were created using a mechanical microkeratome. RESULTS: The VCH-1 was capable of measuring the RIs of all 7 turbid semiliquid media. The average RMS difference between RI estimates according to the VCH-1 and standard subjective Abbé refractometer was 0.003. The mean RI (± SD) of the stroma was 1.369 (± 0.008; range, 1.356-1.390), and the mean age (± SD) of the subjects was 33.7 years (± 8.86; range, 18-56 years). A significant linear correlation was found between age and RI. Least squares regression lines equating RI with age (x, years) was of the form: RI = 1.35711 + 0.00034x (r = +0.383, n = 36, P = 0.011). CONCLUSIONS: RI of the stroma in vivo has a tendency to be increased in older patients when the stroma is resected using a mechanical microkeratome.

Pseudomonas keratitis 4 years after laser in situ keratomileusis.

PURPOSE: To report a patient who presented an infectious keratitis 4 years after laser in situ keratomileusis (LASIK) without any other predisposing risk factor than the LASIK procedure itself. CASE REPORT: We report a 32-year-old man operated by LASIK in January 2006 who presented with infectious keratitis in the OD in April 2010. Clinical examination showed a corneal abscess at 10-o'clock position in the interface and fibrin and Tyndall 4+ in the anterior chamber. Microbiological analysis identified Pseudomonas aeruginosa as the cause of infection. The patient was given ofloxacin, sulfate neomycin, polymyxin B, and prednisolone acetate to be used every 2 h. Treatment led to clinical improvement with resolution of corneal infiltrate. Keratitis with intact epithelium by Pseudomonas can occur up to 4 years after LASIK. CONCLUSIONS: LASIK treatment is a predisposing factor for bacterial keratitis even years after surgery. This report demonstrates the importance of continued postoperative vigilance by patient and his/her clinician.

Postoperative bilateral reading performance with 4 intraocular lens models: six-month results.

PURPOSE: To compare bilateral reading performance within the first 6 months after implantation of 4 intraocular lens (IOL) models. SETTING: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain, and University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Comparative case series. METHODS: Patients had bilateral phacoemulsification and implantation of Acri.Smart 48S monofocal, Acrysof Restor SN6AD3 apodized multifocal, Acri.LISA 366D diffractive multifocal, or Rezoom refractive multifocal IOLs. Bilateral reading performance with and without near correction was evaluated preoperatively and postoperatively using the Salzburg Reading Desk. RESULTS: The study comprised 304 eyes of 152 patients 51 to 90 years old. All groups had a significant improvement in uncorrected and corrected distance visual acuities postoperatively (P≤.01). The apodized multifocal and diffractive multifocal groups had significantly better uncorrected reading acuity than the monofocal and refractive multifocal groups 1 month and 6 months postoperatively (P<.01). Uncorrected reading speed was significantly worse in the refractive multifocal group than in the monofocal group at 1 month (P<.01). The monofocal group had the greatest uncorrected reading distance at 1 month and 6 months (P<.01). CONCLUSION: Multifocal IOLs with a diffractive component provided a comparable reading performance that was significantly better than the one obtained with refractive multifocal and monofocal IOLs.

Quality of life evaluation after implantation of 2 multifocal intraocular lens models and a monofocal model.

PURPOSE: To compare vision-related quality of life using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in patients with 1 of 3 types of intraocular lenses (IOLs) and to correlate it with postoperative visual outcomes. SETTING: Vissum Corporation-Instituto Oftalmológico de Alicante, Alicante, Spain. DESIGN: Comparative case series. METHODS: This study comprised eyes having cataract surgery with bilateral implantation of a monofocal IOL (Group A), apodized multifocal IOL (Group B), or full diffractive multifocal IOL (Group C). Distance and near visual acuities, contrast sensitivity, and quality of life were evaluated preoperatively and postoperatively. RESULTS: The study enrolled 106 eyes (53 patients; age range 49 to 80 years). All groups had significant improvement in uncorrected and corrected distance visual acuities postoperatively (P ≤.05). Near vision outcomes were significantly better in Groups B and C (P ≤.01). Groups B and C had significantly less difficulty in some near tasks, such as reading the newspaper (A-B, P=.02; A-C, P=.02) or reading bills (A-B, P=.04; A-C, P=.004). Group C also had significantly less difficulty driving at night than Group B (P<.01). Near visual acuity and contrast sensitivity were significantly correlated with difficulty in near visual tasks in Groups B and C. Night-driving difficulty correlated significantly with contrast sensitivity in Group B. CONCLUSIONS: Patients with multifocal IOLs could perform several daily tasks at near and intermediate distances, with less night-driving limitation with the full diffractive IOL than with apodized multifocal and monofocal IOLs. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Visual and optical performance with two different diffractive multifocal intraocular lenses compared to a monofocal lens.

PURPOSE: To compare the visual acuity outcomes as well as the ocular optical performance of eyes implanted with either a monofocal or one of two diffractive multifocal intraocular lenses (IOLs). METHODS: One hundred two consecutive eyes of 51 bilateral cataract patients (age 49 to 80 years) were divided into three groups: 22 eyes were implanted with a monofocal IOL (monofocal group), 40 eyes with the Acrysof ReSTOR SN6AD3 IOL (ReSTOR group), and 40 eyes with the Acri.Lisa 366D IOL (Acri.Lisa group). Visual acuity and contrast sensitivity were evaluated pre- and postoperatively. Additionally, ocular optical quality and intraocular aberrations were evaluated postoperatively. RESULTS: Significant improvement after surgery in uncorrected and corrected distance and near visual acuity was observed in all three groups (P≤.05). Uncorrected near visual acuity was significantly better in eyes from the ReSTOR and Acri.Lisa groups compared to the monofocal group (P≤.01). Photopic contrast sensitivity was significantly better for the spatial frequency of 3 cycles/degree in the monofocal group (P<.01). Significantly higher values of the ocular Strehl ratio and cutoff modulation transfer function spatial frequency were also found in the Acri.Lisa group (P=.01). An acceptable range of vision between near and distance peaks was observed in the defocus curves of the ReSTOR and Acri.Lisa groups. CONCLUSIONS: The AcrySof ReSTOR and Acri.Lisa 366D IOLs are able to successfully restore near and intermediate visual function after cataract surgery; however, the Acri.Lisa design seems to provide better optical performance. These results need to be confirmed in a randomized, prospective trial.

Optical analysis, reading performance, and quality-of-life evaluation after implantation of a diffractive multifocal intraocular lens.

PURPOSE: To evaluate the reading performance, changes in quality of life, and optical performance after cataract surgery with multifocal diffractive intraocular lens (IOL) implantation. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Prospective case series. METHODS: Patients with bilateral cataract had implantation of Acri.LISA 366D multifocal IOLs. Visual acuity and contrast sensitivity outcomes were evaluated during a 6-month follow-up. Other parameters evaluated included reading performance (Salzburg Reading Desk), a 25-item quality-of-life questionnaire (National Eye Institute Visual Functioning Questionnaire-25 [NEI VFQ-25] and appendix NEI VFQ-39), and ocular optical performance (ocular aberrometry and modulation transfer function). RESULTS: The study included 48 eyes (24 patients) ranging in age from 47 to 77 years. The mean uncorrected distance visual acuity (logMAR) improved significantly 1 month postoperatively (P<.01), with no significant changes afterward (6 months, P≥.06). The mean reading acuity without correction improved significantly from 0.68 logRAD ± 0.20 (SD) to 0.16 ± 0.08 logRAD 1 month after surgery (P < .01). However, it was worse by the end of the follow-up (6 months, P = .04). During the follow-up, no significant changes were found in the mean reading speed without near correction (6 months, P = .50). Contrast sensitivity improved significantly at all spatial frequencies under photopic and scotopic conditions after surgery (6 months, P≤.02). The quality-of-life index related to reading ability also improved significantly (3 months, P = .03). CONCLUSION: Implantation of the multifocal diffractive IOL significantly improved reading performance, which had a positive effect on the patient's quality of life postoperatively. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Psoriatic intraepithelial keratitis after laser in situ keratomileusis treatment.

UNLABELLED: A 36-year-old woman with chronic psoriasis developed blurring of vision and intraepithelial infiltrates within the flap in the left eye concurrent with the appearance of acute psoriatic generalized skin lesions 14 days after bilateral laser in situ keratomileusis. After treatment with topical antibiotic and steroid agents and topical artificial tears, the intraepithelial infiltrates within the flap completely resolved. The final uncorrected distance visual acuity was 1.0 in both eyes, along with complete resolution of the dermatologic psoriatic lesions. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Factors influencing corneal biomechanical changes after microincision cataract surgery and standard coaxial phacoemulsification.

PURPOSE: To determine the factors affecting corneal biomechanics using biomechanical waveform analysis after microincision cataract surgery (MICS) and standard coaxial phacoemulsification with different incision sizes. SETTING: Vissum-Instituto Oftalmologico de Alicante, Alicante, Spain. METHODS: This prospective nonrandomized study comprised eyes with significant cataract that had MICS (sub-1.8 mm incision) or coaxial phacoemulsification (2.75 mm incision). Corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured by biomechanical waveform analysis (Ocular Response Analyzer) preoperatively, immediately postoperatively, and at 1 month. Results were analyzed and compared between groups. RESULTS: In the MICS group (n = 30), there was a significant increase in Goldmann-correlated intraocular pressure (IOP) and corneal-compensated IOP, although CH decreased in the immediate postoperative period (P<.05). At 1 month, all parameters in the MICS group returned to normal. The coaxial group (n = 30) had an increase in Goldmann-correlated IOP and corneal-compensated IOP, both of which were higher than normal at 1 month. Backward multiple regression analysis showed significant correlations between CH and preoperative Goldmann-correlated IOP and preoperative CRF (r(2) = 0.631, P<.05); between age, axial length (AL), and preoperative CRF (r(2) = 0.418, P<.05); and between the change in CH and AL, total incision length, and preoperative CH (r(2) = 0.429, P<.05). CONCLUSIONS: Cataract surgery with MICS and coaxial phacoemulsification significantly altered corneal biomechanics. Corneal hysteresis was inversely correlated with Goldmann-correlated IOP; CRF was inversely correlated with age and AL. The MICS technique provided more stable corneal biomechanical properties than standard coaxial phacoemulsification 1 month postoperatively.

Visual and accommodative outcomes 1 year after implantation of an accommodating intraocular lens based on a new concept.

PURPOSE: To evaluate visual outcomes and accommodative gains 1 year after implantation of the NuLens accommodating intraocular lens (IOL). SETTING: Department of Refractive Surgery, Vissum Corp., Alicante, Spain. METHODS: This study comprised patients with cataract and atrophic macular degeneration. In each patient, the accommodating IOL was implanted in the eye with the worse visual acuity. At the 12-month follow-up visit, visual acuity and accommodation were measured to determine the efficacy of the IOL. Ultrasound biomicroscopy was used to measure accommodative amplitude. RESULTS: Ten eyes of 10 patients were evaluated. The mean number of lines patients could read increased from 1.0 preoperatively to 3.8 lines 6 months postoperatively, indicating improvement in uncorrected near visual acuity after IOL implantation. The mean change in cross-section measurements of the IOL was 0.06 mm at 1 month; the value peaked at 3 months (0.21 mm), after which it decreased steadily, becoming stable at 9 months (0.09 mm, which is equivalent to 10.00 diopters [D] of accommodation). Corrected near visual acuity improved slightly (0.7 Jaeger lines) at 12 months, with the best reading distance at 10 cm. These results suggest that the near and distance visual acuities were approximately equal and, therefore, the IOL can produce accommodation of 10.00 D. CONCLUSIONS: The accommodation mechanism of the IOL can produce an ocular power variation of 10.00 D. Near visual acuity improved without compromising distance visual acuity.

Conjunctival impression cytology for the diagnosis, follow-up, and treatment in a patient with severe keratoconjunctivitis caused by alkali injury.

PURPOSE: To report a case of severe keratoconjunctivitis after chemical exposure that was treated by a conjunctival-limbal autograft transplantation according to conjunctival impression cytology (CIC) results. METHODS: A 48-year-old woman was diagnosed with a severe keratoconjunctivitis developed after exposure to a mixture of abrasive cleaning agents. Based on CIC results, decision to perform a limbal-conjunctival autotransplantation from the contralateral eye was taken after conventional topical treatment failed to improve symptoms. Polyethersulfone papers were used to take samples from the superior and inferior bulbar conjunctiva of affected and contralateral eyes, and Periodic acid Schiff's (PAS) staining was used to reveal the status of goblet cell (GC) population of the conjunctiva. RESULTS: Tearing, burning sensation, keratitis, squamous metaplasia, and GC improved noticeably, as observed by CIC, after autotransplantation. CONCLUSIONS: CIC helped on the diagnosis, treatment decision, and follow-up of a patient severely affected by alkali exposure by checking the status of GC in the conjunctiva. Limbal-conjunctival autotransplantation decision was taken and performed consequently, and a significant improvement was observed through a follow-up by CIC.

Effect of suction ring application during LASIK on goblet cell density.

PURPOSE: To study the effect of LASIK surgery on conjunctival goblet cells as one of the proposed mechanisms for dry eye occurring after LASIK. METHODS: This prospective study included 22 eyes (11 patients) that underwent LASIK for the correction of myopia. Three pairs of samples were taken from the bulbar conjunctiva of each eye. The first pair was taken preoperatively before application of the suction ring. The second and third pairs were taken from the same sites at 1 week and 1 month consecutively. The first site was at 12 o'clock and the second at the inferotemporal quadrant between 7 and 8 o'clock. Time of suction was recorded. RESULTS: Preoperatively, mean goblet cell density was 424 +/- 105 cells/mm2 (range: 284 to 630 cells/mm2). All postoperative samples showed a statistically significant decrease in goblet cell count: 216 +/- 81 cells/mm2 (range: 40 to 325 cells/mm2) at 1 week and 218 +/- 99 cells/mm2 (range: 50 to 396 cells/mm2) at 1 month. Other parameters of conjunctival impression cytology were normal. The difference between the samples in the inferior conjunctiva preoperatively and 1 week postoperatively was greater than that of the superior conjunctiva. Recovery rate in both sites was similar and the damage did not correlate with the duration of suction. CONCLUSIONS: The application of the microkeratome suction ring induced changes in the perilimbic conjunctiva. These changes contribute to the pathology of dry eye. Goblet cell count remains affected at 1 month postoperatively.