Iritis, glaucoma and corneal decompensation associated with BrightOcular cosmetic iris implant

PURPOSE

NewColorIris cosmetic iris implants have a record of high ocular morbidity and are no longer in use. Newer generation of iris implants, BrightOcular, have patented posterior grooves in order to decrease iris touch and facilitate aqueous flow around the implant. However, little is known about their safety despite their implantations in 10 countries.

METHODS

Collaborative case series of patients who had bilateral implantation of cosmetic iris implants solely for cosmetic reasons.

RESULTS

12 cases were collected being distributed as Caucasian (10) and Asian (2), women (11) and man (1) and with a mean age of 32 years. Ocular manifestations were present in 11 subjects and included anterior uveitis (10 of 12; 83.3%), glaucoma (7 of 12; 58.3%) and corneal decompensation (6 of 12; 50%). Visual acuity was normal in seven, decreased in five with two having visual recovery following explantation of the implant. Glaucoma could not be controlled medically in two patients.

CONCLUSIONS

Cosmetic iris implants carry the risk of ocular damage when implanted in the anterior chamber of normal phakic eyes.

Traumatic insertion of eyelashes into corneal stroma

An unusual case of eyelashes being traumatically inserted into the corneal stroma is presented. A 75-year-old hit her right eye with her own fist, presenting with intra-corneal eyelashes. All remained entirely within the cornea, with no breach of the endothelium. They seemed to have tracked there first through the superior conjunctiva and then the superior limbus. The lashes were surgically removed, with good visual recovery. The authors present a short review of intra-ocular eyelash insertion.

Corneal inlay implantation in a young pseudophakic patient

We describe the surgical correction of a 32-year-old pseudophakic patient with the Kamra corneal inlay. To our knowledge, this is the youngest patient to have such a procedure.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

Complications and management of cosmetic anterior chamber iris implants

PURPOSE

To report the management of complications due to cosmetic iris implantation.

DESIGN

Interventional case report.

METHODS

A 27-year-old female underwent bilateral anterior chamber NewColorIris implants in Panama to cosmetically change her eye colour. Two weeks later she presented as an eye emergency in London with corneal decompensation, raised intraocular pressure and significantly reduced vision. Bilateral explantation was performed with good postoperative recovery.

RESULTS

Three months following explantation, visual acuity had normalized and intraocular pressure was within the normal range without medication.

CONCLUSIONS

Cosmetic iris implantation can lead to potentially sight threatening complications. This is the first case to be reported in the United Kingdom. There is a lack of published safety data and their cosmetic application should be cautioned against.

Visual and refractive outcomes of LASIK with the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-q excimer lasers: a prospective, contralateral study

PURPOSE

To compare the safety, efficacy, and predictability of LASIK with the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-Q excimer laser platforms.

METHODS

This prospective study comprised 44 eyes of 22 consecutive patients who were treated with LASIK using the Moria M2 microkeratome. One eye was treated with the SCHWIND ESIRIS laser and the fellow eye treated with the WaveLight ALLEGRETTO WAVE Eye-Q laser. All eyes operated with the SCHWIND ESIRIS were treated with standard aspheric ablation, whereas the eyes operated with the WaveLight ALLEGRETTO WAVE Eye-Q received treatment with three different ablation types according to the common practice at our clinic. Outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and proximity to target refraction at 6-month follow-up.

RESULTS

At 6 months postoperative, mean decimal UCVA was 0.96+/-0.22 (range: 0.3 to 1.2) for ESIRIS eyes and 0.98+/-0.17 (range: 0.6 to 1.2) for ALLEGRETTO eyes (P=.57). Mean postoperative spherical equivalent refraction was -0.02+/-0.28 diopters (D) (range: -0.75 to +0.75 D) for ESIRIS eyes and 0.11+/-0.91 D (range: -1.00 to +3.88 D) for ALLEGRETTO eyes (P=.49). Of the ESIRIS eyes, 20/22 (91%) were within +/-1.00 D of target refraction and 20/22 (91%) were within +/-0.50 D of target refraction. Of the ALLEGRETTO eyes, 20/22 (91%) and 19/22 (86%) were within +/-1.00 D and +/-0.50 D, respectively, of target refraction. No patient lost > or =2 lines of BSCVA in either group.

CONCLUSIONS

No differences were seen in safety and efficacy outcome parameters between the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-Q excimer lasers when used according to a previously established treatment algorithm at our clinic in the treatment of refractive error.

Airbag-induced corneal flap

PURPOSE

To describe a case of airbag-induced corneal flap in a previously normal cornea.

METHODS

Case report.

RESULTS

A 27-year-old woman presented with complete loss of vision in her left eye following a road traffic accident which involved airbag deployment. There was no previous ocular history. Examination revealed a large corneal flap of 6mm in diameter, extending to the depth of anterior stroma. This was accompanied by a traumatic optic neuropathy. One month follow-up revealed complete reattachment of the corneal flap.

CONCLUSIONS

This is the first reported case of a corneal flap induced by airbag deployment in a cornea with previously normal architecture.

Refractive lens exchange for presbyopia

True presbyopia correction still remains one of the main challenges amongst eye professionals. Many corrective techniques exist including bifocal spectacle correction, monovision techniques both with corrective lenses and surgery, multifocal corneal excimer laser and refractive lens exchange with either accommodating or multifocal lenses. Refractive lens exchange was first described more than 10 years ago and has become more accepted in recent years with advancements in lens technology and improvements in surgical techniques. This article reviews developments in this field and current available lens options in the treatment of presbyopia.

Uses and safety profile of ciclosporin in ophthalmology

Ciclosporin is a calcineurin inhibitor that acts by primarily inhibiting the action of T cells. Clinical trials in the early 1980s demonstrated that systemic ciclosporin was a promising steroid-sparing agent and was also effective in patients who are refractory to treatment with corticosteroids. However, recent years have witnessed the emergence of safer immunosuppressive agents due to the poor side-effect profile of systemic ciclosporin. Topical ciclosporin, however, has a much improved safety profile and is still used to treat a variety of ocular surface disorders including dry eye syndrome, vernal and atopic keratoconjunctivitis, severe blepharitis and high-risk corneal graft patients. This article reviews the uses and safety profile of systemic and topical ciclosporin in ophthalmology, as well as discussing alternative therapeutic agents available.

Airbag induced corneal ectasia

PURPOSE

To report a case of airbag induced corneal ectasia.

METHODS

Case report.

RESULTS

A patient 3 years post-LASIK developed bilateral corneal ectasia worse in the right eye following airbag deployment in a road traffic accident. At last follow up, best corrected vision was 20/40 with -4.00/-4.00 x 25 in the right eye and 20/25 with -1.25/-0.50 x 135 in the left eye.

CONCLUSIONS

This is a rare presentation of trauma induced ectasia in a patient post-LASIK. It is possible that reduction in biomechanical integrity of the cornea from prior refractive surgery contributed to this presentation.

Experience and 12-Month Results of Descemet-Stripping Endothelial Keratoplasty (DSEK) with a Small-Incision Technique

PURPOSE

To report our clinical experience and 12-month results of small-incision Descemet-stripping endothelial keratoplasty (DSEK).

METHODS

Prospective study of 11 eyes of 9 patients who had DSEK. The DSEK technique consisted of stripping the Descemet membrane and endothelium from the recipient cornea. The donor button was prepared by manual dissection and inserted through a 5-mm incision. Air, sulfur hexafluoride (SF6), or perfluoropropane (C3F8) was used both at the end of surgery and in subsequent dislocations to promote donor tissue adherence.

RESULTS

Mean age was 79.6 years (range, 66-91 years), and minimum follow-up was 12 months (range, 12-18 months). Nine eyes had donor tissue dislocation postoperatively, 8 of which received intervention with either SF6 (n = 4) or C3F8 (n = 4). In 1 patient with repeat dislocation, Tisseel glue in combination with C3F8 was used. Preoperative best-corrected visual acuity (BCVA) was 6/24 or worse in all patients. Postoperatively, 6/11 eyes (55%) achieved a BCVA of 6/12 at last follow-up. Mean preoperative cylinder was 1.875 +/- 0.906 D (range, 1-3 D) and postoperatively was 1.5 +/- 1.157 D (range, 0.25-3.25 D). At last follow-up, 6 grafts were clear and 5 had failed. Mean endothelial cell count in the clear grafts at 12-month follow-up was 1078 +/- 507 cells/mm.

CONCLUSIONS

DSEK provided excellent refractive and reasonable visual outcomes in our limited series, but there were frequent problems with dislocation of the donor tissue, and the graft failure rate was high. The graft failures may be linked to excessive endothelial damage, and the high dislocation rate may be linked to not filling the anterior chamber totally with air after insertion of the donor. Further development of the procedure is necessary.

Uses and complications of mitomycin C in ophthalmology

Mitomycin C is a chemotherapeutic agent that acts by inhibiting DNA synthesis. Its use and application in ophthalmology has been increasing in recent years because of its modulatory effects on wound healing. Current applications include pterygium surgery, glaucoma surgery, corneal refractive surgery, cicatricial eye disease, conjunctival neoplasia and allergic eye disease. Although it has been used successfully in these conditions, it has also been associated with significant complications. This article reviews the current trends and uses of mitomycin C in the eye and its reported complications.

Isolated sixth nerve palsy secondary to spontaneous intracranial hypotension

We report the case of a 43-year-old gentleman who presented with an isolated left sixth nerve palsy in association with postural headache. Magnetic resonance imaging showed dural enhancement with downward displacement of the brainstem. This, in association with the signs, symptoms and findings on lumbar puncture, confirmed the diagnosis of spontaneous intracranial hypotension. Treatment was successful with epidural blood patching. The case is discussed and the relevant literature reviewed.

Inadvertent Retention of Descemet Membrane in Penetrating Keratoplasty

PURPOSE

To present a case of inadvertently retained Descemet Membrane (DM).

METHODS

Case report.

RESULTS

A 41-year-old male with previous history of retinal detachment surgery underwent a repeat penetrating keratoplasty; the first graft decompensated secondary to silicone oil. Postoperatively, an inadvertently retained DM was observed forming a physical barrier to the silicone oil.

CONCLUSION

Retained DM is a rare complication of penetrating keratoplasty, with only a few cases reported in the literature. This membrane served a protective role from the effects of silicone oil on the donor cornea but later opacified and required surgical intervention.

Penetration of oral and topical ciprofloxacin into the aqueous humour

AIMS

To investigate the penetration of ciprofloxacin via different modes of administration into the aqueous humour using capillary zone electrophoresis and to determine its prophylactic role in ophthalmic surgery.

METHODS

A prospective study was conducted of 84 patients, divided into two groups, undergoing routine cataract surgery and intraocular lens implantation. Forty patients received 750 mg ciprofloxacin orally the evening before and on the morning of surgery 12 h apart. Forty-four patients received one drop of 0.3% topical ciprofloxacin 90 and 30 min prior to surgery. At the commencement of surgery 0.1-0.2 mL of aqueous fluid was sampled from the anterior chamber and assayed for ciprofloxacin concentration using capillary-zone electrophoresis.

RESULTS

The concentration of ciprofloxacin in the group receiving topical doses was less than 0.1 micro g/mL, which is well below the minimum inhibitory concentration for cipro-floxacin inhibiting 90% (MIC90) of strains of Staphylococcus epidermidis (0.4 micro g/mL). The mean concentration of ciprofloxacin in the aqueous humour of the oral group was 0.26 micro g/mL with a standard deviation of 0.12 micro g/mL (range 0.09-0.67 micro g/mL) with only 12.5% achieving levels higher than MIC90 for S. epidermidis.

CONCLUSION

The topical ciprofloxacin 0.3% as given in this study achieved poor aqueous humour concentration. Oral ciprofloxacin given in this regime should not on its own be considered adequate prophylaxis in intraocular surgery. Capillary zone electrophoresis can be used as an alternative tool to the existing high-pressure liquid chromatography methods for analysing ciprofloxacin level in the aqueous humour.