Surgical Management of Corneal Hydrops: Case Series

Descemet's membrane (DM) rupture/detachments have traditionally been treated conservatively, with limited efficacy and a long rehabilitation period that significantly affects patients' vision and quality of life. Although there are no established gold standards for the timing and nature of treatment, with this series of 4 cases we aimed to highlight the importance of the current optimal intervention methods. The first two patients were treated with anterior chamber injection of isoexpansile 14% C3F8 due to acute hydrops associated with keratoglobus in the first case and keratoconus in the second case. The third patient had keratoglobus and chronic hydrops complicated by multiple stromal clefts detected on anterior segment optical coherence tomography, and the fourth patient had a chronic broad DM detachment which occurred after cataract surgery. Both of these patients were treated with intracameral C3F8 injection together with corneal compressive sutures. In all four cases, DM reattached completely and effectively with surgical intervention. Surgical management of DM rupture/detachment with intracameral gas injection and compressive corneal sutures seems to provide fast symptomatic relief and less healing-related corneal scarring with better visual rehabilitation, and may alleviate the need for corneal transplant surgery in this group of patients.

Cytarabine-Induced Corneal Toxicity: Clinical Features and Relief of Symptoms with Loteprednol Etabonate 0.5% in Two Patients

We report two patients who developed toxic keratopathy following high-dose cytarabine chemotherapy and whose symptoms resolved following topical loteprednol etabonate 0.5% treatment. A 25-year-old woman and a 26-year-old man with acute myeloid leukemia were referred to our department with symptoms of ocular discomfort, photophobia, and blurred vision after consolidation chemotherapy. Central corneal epithelial microcysts were observed bilaterally in both patients, and in vivo confocal microscopy showed highly reflective disseminated granular and irregular intraepithelial opacities, mainly in the basal epithelial layers. Loteprednol etabonate 0.5% relieved both patients' symptoms in less than a week, and the microcysts disappeared in 2 to 3 weeks of treatment. Although there is no standardized treatment protocol for cytarabine-induced corneal toxicity, dexamethasone 0.1% and prednisolone phosphate 1.0% were reported to be effective in the resolution of discomfort and symptoms. In the two patients we report herein, loteprednol etabonate 0.5% four times daily was also effective in suppressing the symptoms.

Clinical and in vivo confocal microscopy findings in patients receiving tamoxifen citrate.

PURPOSE: : To describe the deposition rate of tamoxifen in the cornea and observe its impact on the cornea with confocal microscopy. METHODS: : Forty-four eyes of 22 women receiving tamoxifen at a dosage of 20 mg/day for at least 6 months for the adjuvant treatment of breast cancer and 30 eyes of 15 healthy age-matched women were examined for corneal drug deposition by slitlamp after pupil dilation. Ultrasound pachymetry, specular microscopy, in vivo confocal microscopy, and Schirmer tear test were also performed in all patients. RESULTS: : The mean duration of tamoxifen intake was 21.6 +/- 7.9 months (range, 13-44 months), and the mean cumulative dose was 12.9 +/- 4.7 g (range, 7.8-26.4 g). Drug depositions in the inferior paracentral cornea were identified in 32 (72%) eyes at pupil-dilated slitlamp examination. There were no significant differences between eyes with keratopathy, those without keratopathy, and control eyes in regard to the mean Schirmer test scores, mean central corneal thickness, mean endothelial cell count, mean basal epithelium cell density, mean anterior and posterior stromal keratocyte density, and mean endothelial cell density (P > 0.05). No pathologic alteration of structure was observed with in vivo confocal microscopy at any corneal level in patients receiving tamoxifen. CONCLUSIONS: : Low-dose tamoxifen use was associated with corneal depositions in 72% of patients. Slitlamp examination performed with pupil dilation was helpful in detection of subtle tamoxifen-related deposits. Amelioration of in vivo confocal microscopy systems may be helpful in accurate imaging of the paracentral and peripheral cornea.

Corneal thickness measurements in normal and keratoconic eyes: Pentacam comprehensive eye scanner versus noncontact specular microscopy and ultrasound pachymetry.

PURPOSE: To compare central corneal thickness (CCT) measurements taken with the Pentacam comprehensive eye scanner (CES), noncontact specular microscopy (SM), and ultrasound pachymetry (UP) in normal and keratoconic corneas. SETTING: Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey. METHODS: In a prospective study, 3 CCT measurements were taken with the Pentacam CES, SM, and UP in that sequence from 1 eye of 45 consecutive patients with myopia (group A) and 62 consecutive patients with keratoconus (group B). Eyes with keratoconus were further divided into 3 subgroups, mild, moderate, and severe, according to the mean keratometry readings. RESULTS: Pentacam CES (r = 0.994) and UP (r = 0.993) demonstrated very high and comparable reproducibility in group A. In group B, Pentacam CES displayed better reproducibility (r = 0.988) than UP (r = 0.969) and SM (r = 0.901). The mean CCT measurements of Pentacam CES and UP were not significantly different in group A (P = .37) and in eyes with mild keratoconus (P = .29), whereas significant differences between all instrument pairs were evident in group B and in moderate and severely keratoconic eyes (P<.05). Noncontact SM measurements were significantly smaller than those of Pentacam CES and UP in all groups (P<.05) when a measurement could be obtained. There were significant linear correlations between CCT measurements of Pentacam CES, UP, and noncontact SM in groups A, B, and mildly keratoconic eyes (P<.001). CONCLUSIONS: Results suggest that whereas Pentacam CES and UP may be used interchangeably in normal eyes in the clinical setting for the measurement of CCT, one should be cautious interpreting corneal thickness data from Pentacam CES, UP, and particularly SM in eyes with keratoconus. Whereas, in normal and mildly keratoconic eyes, Pentacam CES and UP demonstrated very high and comparable reproducibility, in moderately keratoconic eyes, Pentacam CES readings showed better reproducibility than UP.