RESUMO
Keloid following circumcision has been described in the literature despite the rarity of its occurrence in penile skin. In this paper, we review the literature and report the successful management of post-circumcision keloid scarring in a 2-year-old boy. After circumcision a 2-year-old boy of African origin developed keloid scarring at the circumcision site. This was treated with three intralesional injections of triamcinolone acetate over 3 months, followed by surgical excision. There was no recurrence at 6 months after excision. To our knowledge this is the 12th case of keloid following paediatric circumcision described in the literature. There is a wide range of techniques described but all are recurrence free at 6 months following repeated intralesional triamcinolone acetate injection and surgical excision. While there is no current consensus in treating post-circumcision keloid, we find that intralesional injection followed by surgical excision provides an acceptable aesthetic result, which is recurrence free.
RESUMO
PURPOSE: To evaluate outcomes of high hyperopic LASIK using the MEL 80 excimer laser (Carl Zeiss Meditec, Jena, Germany). METHODS: Retrospective analysis of 830 consecutive high hyperopic LASIK procedures using the MEL 80 excimer laser and either the VisuMax femtosecond laser (Carl Zeiss Meditec) or zero compression Hansatome microkeratome (Bausch & Lomb, Rochester, NY). Inclusion criteria were attempted hyperopic correction of +4.00 diopters [D] or higher in one axis and corrected distance visual acuity (CDVA) of 20/20 or better. Patients were observed for a minimum of 1 year. Epithelial thickness monitoring by Artemis very high-frequency (VHF) digital ultrasound (ArcScan Inc., Morrison, CO) was used to evaluate potential for further steepening as a re-treatment. RESULTS: One-year data were available for 785 eyes. Mean attempted spherical equivalent refraction (SEQ) was +4.52 ± 0.84 D (range: +2.00 to +6.96 D) for the primary treatment and mean cylinder was 1.05 ± 0.86 D (range: 0.00 to 5.25 D). Mean age was 50 ± 12 years (range: 18 to 70 years) and 61% were women. Postoperative SEQ was ±0.50 D in 50% and ±1.00 D in 77% of eyes after primary treatment. After re-treatment, 67% of eyes were within ±0.50 D and 89% were within ±1.00 D. Uncorrected distance visual acuity was 20/20 or better in 76% of eyes after final treatment. One line of CDVA was lost in 25% of eyes and two lines were lost in 0.4%. There was a clinically insignificant but statistically significant decrease (P < .05) in contrast sensitivity (CSV-1000) by less than 1 log unit at 3 and 6 cycles per degree (cpd) and by 1 log unit at 12 and 18 cpd. Diurnal fluctuation in refraction was identified in 2 eyes, proven by VHF digital ultrasound to be due to diurnal epithelial remodeling overnight and unrelated to maximum postoperative keratometry induced. CONCLUSIONS: LASIK for hyperopia by cumulative treatment of up to +8.33 D with the MEL 80 excimer laser was found to satisfy accepted criteria for safety, efficacy, and stability when applying specialized protocols, including epithelial monitoring. [J Refract Surg. 2017;33(5):314-321.].