Long-term outcomes of penetrating keratoplasty for corneal complications of herpes zoster ophthalmicus.

BACKGROUND/AIM: To review the long-term outcomes of penetrating keratoplasty (PKP) for corneal complications of herpes zoster ophthalmicus (HZO). METHODS: We reviewed the medical records of 53 eyes of 53 patients who underwent PKP due to corneal complications of HZO at the Kellogg Eye Center. RESULTS: The mean age of patients at the time of PKP was 68.0±16.4 years, with a follow-up of 4.0±3.8 years and quiescent period of 6.5±5.3 years from active HZO to PKP. Preoperatively, 25 (47.2%) eyes were completely anaesthetic, while 16 (30.2%) had deep corneal neovascularisation in four quadrants. Comorbid ocular disease, including cataract, glaucoma and macular disease, was present in 25 (47.2%) eyes. Twenty patients (37.8%) received acyclovir for the entire postoperative period. There were no recurrences of zoster keratitis in any eye. The most common complications were difficulty healing the ocular surface (12/53, 22.6%) and glaucoma (14/53, 26.4%). Thirty per cent of the eyes required one or more additional postoperative procedures, most commonly tarsorrhaphy (10/53, 18.9%) and amniotic membrane graft (6/53, 11.3%). At 1, 2-4 and ≥5 years, 94%, 82% and 70% grafts remained clear, respectively. Visual acuity improved at 1 year postoperatively (p<0.0001), but this improvement was not sustained. There was no significant benefit of long-term acyclovir on visual acuity (p=0.2132) or graft survival (p=0.241). CONCLUSIONS: Even in eyes with significant preoperative risk factors, PKP for the corneal complications of HZO can achieve favourable tectonic and visual results. Although most grafts remained clear, long-term visual potential may be limited by comorbid ocular diseases. Prophylactic postoperative oral acyclovir did not improve outcomes.

Solitary epibulbar neurofibroma in older adult patients.

PURPOSE: To report a solitary epibulbar neurofibroma in 2 elderly patients without systemic neurofibromatosis. METHODS: Case reports and literature review. RESULTS: A 67-year-old man presented with a 2-month history of left epibulbar mass. On slit-lamp examination, an 8- × 8-mm amelanotic, translucent, gelatinous, circumscribed lesion was present deep to the nasal bulbar conjunctiva. A 60-year-old otherwise healthy man presented with a 6-week history of a subconjunctival growth causing pain and photophobia in his right eye. On slit-lamp examination, an 8- × 8-mm amelanotic, translucent, gelatinous, circumscribed subconjunctival lesion, causing a delle was present near the nasal limbus. In each case, excisional biopsy was performed and histopathologic study revealed the diagnosis of neurofibroma. In both cases, after 12 months of follow-up, there was no evidence of recurrence or systemic disease. CONCLUSIONS: Solitary epibulbar neurofibroma in older adult patients without systemic neurofibromatosis is rare but should be considered in the differential diagnosis of epibulbar tumors.

Acute hydrops with corneal perforation in post-LASIK ectasia.

PURPOSE: To report a case of corneal hydrops with perforation in a patient with ectasia after undergoing laser in situ keratomileusis (LASIK). METHODS: An observational study with clinical, optical coherence tomographic, and histopathologic findings. RESULTS: A 41-year-old woman had an acute onset of blurry vision, pain, photophobia, tearing, and foreign body sensation in the right eye 10 years after undergoing unilateral LASIK in Jordan. According to her, the surgeon elected not to operate on the left eye because of a "corneal abnormality." On slit-lamp examination, a tear in Descemet membrane with a stromal cleft extending to the overlying LASIK flap interface was noted. The flap was partially dehisced by a diffuse channel of aqueous humor draining from the cleft and streaming out the temporal flap edge. When leakage failed to stop after 2 weeks of treatment with a bandage contact lens, the patient underwent penetrating keratoplasty. Histopathological examination of the host button showed a fluid-filled cleft connecting the flap interface. Slit-lamp examination and corneal topography of the contralateral left eye were consistent with keratoconus. CONCLUSIONS: Corneal hydrops with perforation in the setting of post-LASIK ectasia is extremely rare and may be associated with flap dehiscence requiring penetrating keratoplasty.