Corneal densitometry after photorefractive keratectomy, laser-assisted in situ keratomileusis, and small-incision lenticule extraction

PurposeThe aim of this study was to gain greater insight into the corneal densitometry changes occurring as a result of refractive surgery and to compare these changes across three widely used surgical techniques, namely, photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis with a femtosecond laser (LASIK-FS), or ReLEx small-incision lenticule extraction (ReLEx SMILE).Patients and methodsThree hundred and thirty-six patients (184 male and 152 female patients) participated in this study. They were split into three groups according to the refractive surgery technique they had undergone: LASIK-FS (74 patients), PRK (153 patients), and ReLEx SMILE (109 patients). All participants underwent an exhaustive eye examination both before and after surgery. Pre- and postoperative corneal densitometry was measured using an Oculus Pentacam system.ResultsThe mean postoperative total corneal densitometry values were 16.53±1.94 for the LASIK-FS group, 15.53±1.65 for PRK, and 16.10±1.54 for ReLEx SMILE. When corneal densitometry was analyzed for specific corneal areas, the values corresponding to the 0-2, 2-6, and 6-10 mm annuli were similar across the three surgical techniques. The only region in which differences were found was the peripheral area (P<0.05), but these variations across techniques were not statistically significant.ConclusionsCorneal densitometry can be used as an objective metric to assess corneal response to refractive surgery, and to monitor patients over time. Corneal densitometry was not negatively affected by any of the refractive surgical procedures under evaluation.

[Acute idiopathic blind spot enlargement syndrome associated with choroidal neovascularization]

CLINICAL CASE

A 17 year old female consulting due to photopsia and a sudden loss of visual field in left eye (OS), with previous contralateral choroidal neovascularization. The examination suggested an acute idiopathic blind spot syndrome. The progress without treatment was favorable, with a reduction in the scotoma and without a worsening of her visual acuity.

DISCUSSION

This case report is about an unusual and benign syndrome, typical of young women. Differential diagnosis must be made between the evanescent white dot syndrome and the acute zonal occult outer retinopathy. To our knowledge, this is the first published case associated with choroidal neovascularization, a fact that leads us to question its benignancy.

[Prospective randomized trial comparing Discovisc versus Healon in phacoemulsification]

OBJECTIVE

To compare the intraoperative behaviour of both, DisCoVisc and Healon used as viscoelastics in cataract surgery.

METHOD

We prospectively evaluated 35 patients with cataracts who underwent phacoemulsification and intraocular lens implantation. Patients were randomized into two groups. Group A included 17 patients in where Healon was used as a viscoelastic, whereas group B included 18 patients in where the viscoelastic used was DisCoVisc. After each procedure, the surgeon filled in a questionnaire describing the behaviour of the viscoelastic during the different stages of phacoemulsification.

RESULTS

DisCoVisc behaved as both cohesive and dispersive viscoelastic during capsulorrhexis, phacoemulsification and viscoelastic aspiration, whereas Healon acted as a cohesive substance during all surgical stages. DisCoVisc enabled better visualization and transparency during all the surgical stages and maintains the capsular bag better during the intraocular lens implantation. Viscoelastic aspiration was easier with Healon.

CONCLUSIONS

DisCoVisc is a new viscosurgical device with both cohesive and dispersive properties, which avoids using two different viscoelastics to improve the performance at different surgical stages. DisCoVisc has been shown to be more transparent and provides better anterior chamber maintenance when compared with Healon. Healon was more easily aspirated due to its cohesive character.

[Retrobulbar optic neuritis associated with Infliximab]

CASE REPORT

We report the case of a 76-year-old woman who attended our hospital because of a sudden loss of visual acuity in her left eye. The problem appeared to be that of retrobulbar optic neuritis. However, the age of the patient together with the simultaneous use of Infliximab to treat her rheumatoid arthritis, suggests the demyelination may have been associated with the Infliximab use.

DISCUSSION

TNFa inhibitors (including Infliximab) are associated with demyelinating diseases including optic neuritis.

[Floppy-iris syndrome associated with tamsulosin. A prospective case-control study]

OBJECTIVE

The main objectives of this study were: To assess the incidence of the intraoperative floppy-iris syndrome associated with tamsulosin and to analyse the incidence of intraoperative and postoperative complications as compared to a control group. Secondary objectives were: to describe the pupillary modifications associated with tamsulosin and to quantify the endothelial cell loss.

METHODS

A prospective review of 38 eyes of 38 patients was performed. Patients were assigned to two different groups. Group 1 (cases) included 19 eyes of 19 male patients taking tamsulosin, and group 2 (controls) included 19 eyes of 19 male patients not taking tamsulosin.

RESULTS

Only two patients (10%) of our study had the complete triad seen in floppy-iris syndrome; 9 patients (47%) showed 2 of the 3 main features of the syndrome and only 2 patients showed iris billowing during phacoemulsification. None of the patients in group 2 showed any of the characteristic intraoperative features. The complication rate was similar in both groups.

CONCLUSIONS

Intraoperative floppy-iris syndrome occurred in 67% of the patients treated with tamsulosin. The only postoperative secondary effect was a lower pupil reactivity in patients taking tamsulosin.

Effects of bacterial adhesion with respect to the type of material, structure and design of intraocular lenses

The properties of the biomaterials used to constitute lenses are important factors choosing a lens for human implantation because these can influence in posterior clinical evolutions of patients. In this study, different characteristics of intraocular lenses such as chemical composition, surface roughness and lens design have been investigated in terms of their influence into a pathological environment. Eight commercial lenses were tested by optical profiling, Infrared spectra with Fourier transformation (FTIR), water-material contact angle and scanning electron microscope (SEM) to know their chemical composition and structural characteristics. These lenses were then exposed to infectious conditions in order to evaluate their responses to the bacterial environment.

[Melanocytoma of the ciliary body]

CLINICAL CASE

We report the case of a 25 year old woman who attended our Hospital with a pigmented lesion in anterior chamber angle of her right eye. She complained of reduced visual acuity on the same eye. On examination, and once complementary tests were performed, a pigmented lesion located on the iris root and ciliary body of her right eye was confirmed. A decision to perform a local resection was made and there were no surgical complication. Histology results confirmed the diagnosis of ciliary body melanocytoma.

DISCUSSION

Ciliary body melanocytoma is a benign rare lesion with only 40 cases described in the literature. A local resection of this benign lesion should be considered as alternative to enucleation, even though differential diagnosis with malignant melanoma must also be considered.

[Surgical arteriovenous decompression (sheathotomy) in branch retinal vein occlusion: retrospective study]

PURPOSE

To evaluate best-corrected visual acuity (BCVA), incidence of neovascularization and angiographic changes in patients with branch retinal vein occlusion (BRVO) treated with surgical decompression by sheathotomy.

METHODS

Retrospective study including 17 cases of temporal BRVO with macular edema treated with surgical decompression. Results of BCVA, incidence of neovascularization and vitreous hemorrhage 6 months following surgery are included. Angiographic changes in the first 8 cases a month after decompression are also evaluated.

RESULTS

The mean postoperatory BCVA was 0.40 with a mean improvement of 0.26. Seventy one percent of patients (12/17) improved 2 or more visual acuity lines and 53% of patients (9/17) improved 4 or more lines. Only in one case the vision worsened. There was no evidence of retinal neovascularization or rubeosis iridis six months after surgery.

CONCLUSIONS

Surgical decompression is a therapeutical option for those patients suffering BRVO with macular edema. Our initial results are encouraging, not only regarding visual acuity improvement, but also because of a decreased risk of neovascularization. No patient included in our study developed neovascularization.

[Study of two immunosuppresive strategies after limbal allograft transplantation]

PURPOSE

Comparison of two immunosuppressive strategies after limbal allograft transplantation in an experimental model of ocular surface chemical burn.

METHODS

Twenty albino rabbits underwent corneal and limbal chemical burn with NaOH. One week later limbal transplantation was performed. Clinical assessments included measurements of epithelial defect, stromal opacity and neovascularization areas, using a computerized planimetry system 0, 7, 15, 30, 60 and 90 days after the chemical burn. Histologic examination was performed at 3 months, after sacrifice of the animals. Two immunosuppressive strategies were evaluated: topical cyclosporin A on constant dosage (group 1), and a combination of topical cyclosporin A and dexamethasone followed by a tapered dosage of topical cyclosporin A (group 2).

RESULTS

No statistical differences were observed between both groups regarding all of the variables 3 months after the chemical burn. Differences in the stromal opacity area were detected on day 7 (43.33 D.E. 4.84 vs 36.67 D.E. 3.88; p<0.01), day 15 (41.68 3 D.E.95 vs 33.6 D.E. 1.99; p<0.01), and day 30 (40.1 D.E. 5.45 vs 32.52 D.E. 7.33; p<0.05). As for the neovascularization area, differences were detected on day 7 (1.92 D.E. 0.48 vs 3.73 D.E. 1.18; p<0.01), day 15 (7.08 D.E. 1.54 vs 4.42 D.E. 1.68; p<0.01), and day 60 (4.9 D.E. 2.58 vs 9.65 D.E. 5.55; p<0.05).

CONCLUSIONS

There are no long-term differences between both immunosuppressive strategies regarding all the studied variables (Arch Soc Esp Oftalmol 2003; 78: 29-34).

Keratomycosis after cataract surgery

PURPOSE

To evaluate cases and results of keratomycosis that developed after cataract surgery.

SETTING

Hospital de Guipúzcoa, San Sebastián, Spain.

METHODS

This retrospective study comprised 8 patients who developed keratomycosis soon after cataract surgery.

RESULTS

Culture analysis revealed 7 cases of Aspergillus fumigatus and 1 of Aspergillus flavus. After medical treatment with antifungal agents, 6 cases resolved and 2 required evisceration.

CONCLUSIONS

The presence of fungi in corneal ulcers that develop after cataract surgery should be considered. Initiation of early treatment determines the prognosis. Among the therapeutic options, collagen shields soaked in amphotericin B may be effective.

[Impact of 3 years of contract implementation on the quality of cataract surgery]

OBJECTIVE

To assess the adequacy to clinical practice of cataract procedures contracted in the Gipuzkoa Health Area (in public as well as concerted hospitals) from 1995. A second aim is to identify the achievements obtained three years after its implementation comparing the data with those of 1994, a year before.

METHODS

Before its implementation a multidisciplinar team established the number of surgical procedures to be contracted each year by age and sex, as well as the technical and quality conditions (out-patient surgery, loco-regional anaesthetic, facoemulsification, etc.). Data used for the assessment: Cataracts Registry of the Ophthalmologic Unit, Patient Management Categories and surgical waiting lists.

RESULTS

During the period studied, 8,073 cataract operations were performed, 9% higher than expected. The distribution by age and sex was as estimated. Technical and quality standards were fulfilled, except for the surgical waiting list, in at least 75% of the procedures. The surgical technique mainly used was facoenmulsification, increasing from 15% in 1994 to 76.5% in 1997.

CONCLUSION

The contracting of cataract surgery has allowed the assessment, reordering, and establishment of standards of care for all the professionals involved in the process. There were improvements in clinical practice during the period studied. This has given raise to the homogenisation of care in all the units following technical and quality standards, meaning better equity for the patients in need of the procedure.

Topical cyclosporin A 2% in the treatment of vernal keratoconjunctivitis

Topical cyclosporin A at a 2% concentration was used for 6 months in the management of 2 patients with vernal keratoconjunctivitis who had failed to respond to conventional therapy. We used one drop every 6 hours in both eyes during the first month and every 12 hours during the remaining 5 months. Clinical controls were carried out weekly during the first month, monthly during the 6 month period and every 2 months thereafter. Cyclosporin A blood levels and serum creatinine were regularly monitored in both patients. Within the first month, both the symptoms and signs of the condition, in particular papillary proliferations, improved significantly and these results were maintained throughout the entire period of treatment and during 2 years of follow-up with conservative management (artificial tears).

The use of collagen shields impregnated with amphotericin B to treat Aspergillus keratomycosis

We treated three patients with Aspergillus keratomycosis with collagen shields soaked in amphotericin B (0.50%) for 2 hours at 25 degrees C before application. These shields, replaced daily, were used in conjunction with amphotericin B (0.25%) eye drops, which were applied every 2 hours. Cultures from the eyes of all patients became negative within 15 days of treatment. Subsequently, two patients required keratoplasty. The results suggest that collagen shields prepared this way deliver an adequate concentration of amphotericin B to the cornea, aid its tolerance, and improve the prognosis of Aspergillus keratomycosis. Further studies are needed to define the minimum therapeutic concentrations necessary to inhibit the growth of the fungus and to avoid a toxic effect on the cornea.

[Multiple sphincterotomies in the surgical treatment of cataracts in narrow pupils]

Deficient mydriasis of diverse etiology renders extracapsular cataract extraction and posterior chamber intraocular lens implantation technically difficult. Several techniques are available to improve surgical results when this problem is present. We have used multiple sphincterotomies in 6 patients with narrow pupils undergoing cataract extraction. We discuss the indications, intraoperative complications and postoperatory evolution of these cases.