Intraocular pressure changes before and after surgery for spontaneous in-the-bag intraocular lens dislocation.

PURPOSE: To evaluate changes in intraocular pressure (IOP) after surgical correction of spontaneous late in-the-bag intraocular lens (IOL) dislocation. SETTING: Two tertiary referral hospitals in Spain. DESIGN: Retrospective case series. METHODS: Cases of in-the-bag IOL dislocation from 2004 to 2014 were included. The IOP and grade of IOL dislocation were correlated before surgery. The IOP and number of drugs to treat glaucoma were compared before and after surgery in cases with more than 6 months of follow-up in the whole group and in separate groups according to the technique used to correct IOL position. RESULTS: This study evaluated 134 eyes. The mean IOP at diagnosis decreased significantly as the grade of dislocation increased (P = .012). After surgery, the mean corrected distance visual acuity improved significantly and the mean IOP decreased significantly after surgery in all groups (both P = .000); the IOP decrease was significantly more pronounced in the glaucoma group than in the entire sample (P = .011). No statistically significant differences were detected in preoperative or postoperative IOP between the surgical technique groups. There was no significant increase in the number of drugs to treat glaucoma (P = .064). CONCLUSIONS: There was a significant trend toward a decrease in IOP as the grade of IOL dislocation increased. The IOP decreased significantly after surgical management of in-the-bag dislocated IOLs without a significant increase in number of drugs to treat glaucoma. The decrease was independent of the technique used to correct IOL dislocation.

Confocal microscopy of stage 4 diffuse lamellar keratitis with spontaneous resolution.

PURPOSE: To report confocal microscopic findings at the onset of stage 4 diffuse lamellar keratitis and after its resolution. Stage 4 is the most severe form of diffuse lamellar keratitis. Its incidence is approximately 1 in 5000 and is associated with stromal melting, deep flap folds, central haze, hyperopic shift, irregular astigmatism, and severe decrease in visual acuity. METHODS: A 22-year-old woman underwent bilateral uncomplicated laser in situ keratomileusis (LASIK) for myopia. Postoperative course in the right eye was uneventful; however, in the left eye, stage 4 diffuse lamellar keratitis developed. Confocal microscopy examination was performed in both eyes at the onset of the syndrome and after its resolution. Findings in the eye with diffuse lamellar keratitis (left eye) were compared with the uninvolved (right) eye. RESULTS: The condition improved spontaneously and 2 years later, slit-lamp microscopy showed resolution of the folds and haze with subsequent improvement of visual acuity. However, confocal microscopic examination in the left eye revealed a persistent stromal subclinical haze on both sides of the lamellar cut and prominent folds that extended into the anterior stroma. CONCLUSION: Confocal microscopy revealed that in spite of normal appearance on slit-lamp microscopy, micromorphological alterations persisted after spontaneous resolution of stage 4 diffuse lamellar keratitis.