Topography-Guided Custom Ablation Photorefractive Keratectomy Treatment of Irregular Astigmatism Resulting From Decentered SMILE.

PURPOSE: To describe the use of topography-guided custom ablation treatment with photorefractive keratectomy (T-CAT PRK) to correct irregular astigmatism and visual aberrations resulting from decentered small incision lenticule extraction (SMILE). METHODS: Case report and literature review. RESULTS: A 41-year-old woman experienced blurred uncorrected distance acuity (UDVA), reduced corrected distance acuity (CDVA), and monocular diplopia in one eye following SMILE due to treatment decentration. Retrospective review of the surgical video provided visual cues to the impending decentration at multiple points during the docking process and lenticule creation. Re-treatment was performed using T-CAT PRK with mitomycin C application with off-label use of the EX500 excimer laser (Alcon Laboratories, Inc). Treatment resulted in improvement in UDVA and CDVA to 20/12; reduced higher order aberrations, particularly vertical coma (-0.65 µm to 0.197 µm); topographic pattern centration; and subjective symptom resolution. CONCLUSION: Recognition of subtle visual cues at the time of SMILE docking can provide critical feedback to avoid treatment decentration. T-CAT PRK can be a useful treatment option when decentration occurs. [J Refract Surg. 2020;36(11):766-771.].

Apremilast Use in a Case of Cicatricial Ectropion Secondary to Severe Lamellar Ichthyosis.

Ichthyosis is a cutaneous disorder characterized by excessive amounts of dry thickened skin surface scales. Ocular manifestations of ichthyosis include cicatricial ectropion, which may cause exposure keratoconjunctivitis and rarely corneal perforation. Topical emollients, anti-inflammatory ointments, and systemic retinoids have been used to control the disease process, while surgical correction with donor graft has been reserved for severe cases involving corneal exposure. The authors report a case of a Caucasian male with lamellar ichthyosis with severe bilateral upper and lower eyelid cicatricial ectropion and corneal ulceration requiring surgical correction. Treatment with apremilast, a novel phosphodiesterase-4 inhibitor, for the treatment of a concomitant plaque psoriasis achieved good control of his skin diseases and minimized the recurrence of eyelid ectropion.

Bacterial biofilm diversity in contact lens-related disease: emerging role of Achromobacter, Stenotrophomonas, and Delftia.

PURPOSE: Multi-species biofilms associated with contact lens cases and lenses can predispose individuals to contact lens-related inflammatory complications. Our study used culture-independent methods to assess the relationship between the severity of contact lens-related disease and bacteria residing in biofilms of contact lens cases and lenses. METHODS: Contact lens cases and lenses from 28 patients referred to the West Virginia University Eye Institute and diagnosed as having mild keratitis, keratitis with focal infiltrates, or corneal ulcers were processed and evaluated for bacterial composition based on 16S ribosomal RNA gene sequencing. Cases and lenses from nine asymptomatic contact lens wearers were processed in a manner similar to controls. Relationships between disease severity, bacterial types, and bacterial diversity were evaluated statistically. RESULTS: Disease severity and presenting visual acuity correlated with an increase in the diversity of bacterial types isolated from contact lens cases. A significant difference also was observed in the number of bacterial types associated with the three clinical groups. Achromobacter, Stenotrophomonas, and Delftia were prevalent in all disease groups, and Achromobacter and Stenotrophomonas were present in one asymptomatic control. Scanning electron microscopy revealed that Achromobacter and Stenotrophomonas formed a biofilm on the surface of contact lenses. CONCLUSIONS: Culture-independent methods identified an association between disease severity and bacterial diversity in biofilms isolated from cases and lenses of patients with contact lens-related corneal disease. Achromobacter, Stenotrophomonas, and Delftia were predominant bacteria identified in our study, drawing attention to their emerging role in contact lens-related disease.

Microkeratome-assisted anterior lamellar keratoplasty.

Microkeratome-assisted anterior lamellar keratoplasty has emerged as a surgical option for conditions affecting the clarity of the outer 200 mum of the cornea. Herein we describe the outcome of a simple procedure in which the excimer laser can be used to augment deep tissue removal after both recipient bed and donor graft are prepared with the microkeratome. Our noncomparative interventional case series involved 5 eyes of 4 patients with lattice corneal dystrophy who underwent microkeratome-assisted anterior lamellar keratoplasty. Outcome measures include preoperative and postoperative best spectacle-corrected Snellen visual acuity. Visante ocular coherence tomography data are reported for several of the patients.

Tectonic lamellar keratoplasty utilizing a microkeratome and an artificial anterior chamber system.

PURPOSE: To describe a technique and report results of tectonic lamellar keratoplasty using tissue harvested with a microkeratome from a corneoscleral rim mounted in an artificial anterior chamber system. METHODS: A donor lenticule was prepared from a corneoscleral rim utilizing the Moria LSK-1 (Moria/Microtek Inc., Doylestown, PA, U.S.A.) microkeratome and artificial anterior chamber. This tissue was used in the procedures of 6 eyes of 6 patients requiring tectonic lamellar keratoplasty. Three eyes were in danger of imminent perforation due to corneal ulceration. Other indications for lamellar engraftment include persistent wound leak following cataract extraction, persistent epithelial defect following a Grade 4 chemical burn, and limbal dermoid. RESULTS: A successful outcome, defined as restoration or preservation of globe integrity, vision, and intact epithelium, was achieved in all patients. Follow-up ranged from 2-8 months with a mean of 4.5 months. CONCLUSIONS: Donor lenticules prepared with the ALTK (Moria/Microtek Inc.) system can be used in the successful management of eyes requiring tectonic lamellar keratoplasty.

Predictability of donor lamellar graft diameter and thickness in an artificial anterior chamber system.

PURPOSE: To identify factors affecting the predictability and report results of donor lamellar graft diameter and thickness in an artificial anterior chamber obtained with a microkeratome. METHODS: Lamellar lenticules were obtained from 25 human corneoscleral rims mounted in an artificial anterior chamber. Lenticules measuring 9 mm were attempted at two thicknesses (250 microm and 350 microm heads). Intrachamber pressure of 65 mm Hg was confirmed with Barraquer tonometry. Keratometry, pachymetry, limbal white-to-white, and qualitative mires with the diameter applanation lens were evaluated as possible factors predictive of lenticule diameter and thickness. Diameters and thicknesses were measured with calipers and pachymetry, respectively. RESULTS Ninety-two percent (23/25 lenticules; 14/15 in 250 microm, 9/10 in 350 microm) were +/- 0.25 mm of the intended diameter and 76% (19/25 lenticules; 12/15 in 250 microm, 7/10 in 350 microm) were within +/- 100 microm of the intended thickness. Ovoid applanation mires with the diameter applanation lens represented tissue herniation within the artificial anterior chamber and led to ovoid lenticules (2/25). CONCLUSIONS: Lenticules of 9 mm +/-0.25mm in diameter were highly reproducible with proper corneoscleral rim seating. Intrachamber pressure confirmed with Barraquer tonometry is important in obtaining lenticules of consistent diameter and adequate thickness. Ovoid applanation mires may herald improper corneoscleral rim seating and result in a similarly shaped lenticule. A 2 mm or greater corneoscleral rim is recommended to prevent tissue herniation within the artificial anterior chamber used in this study.