Corneal ulceration in a LASIK patient due to vitamin a deficiency after bariatric surgery.

PURPOSE: To review the case of a 41-year-old woman who underwent bariatric surgery in 2000. She subsequently underwent laser in situ keratomileusis (LASIK) surgery in 2008 and complained of dry eye since the LASIK surgery. In November 2010, she was diagnosed with a corneal melt and was treated with aggressive lubrication, followed by eventual amniotic membrane placement and a tarsorrhaphy. She then presented for consultation at the Bascom Palmer Eye Institute when she developed a corneal infiltrate. She was diagnosed with fungal keratitis with corneal xerosis. At that time, vitamin A levels were measured and were less than 2 µ/dL. The patient admitted noncompliance with nutritional supplements. METHODS: Case report. RESULTS: The patient was treated with aggressive lubrication and natamycin. Vitamin supplements were restarted, and the patient experienced dramatic improvement in symptoms with resolution of the infection. A central corneal scar with corneal thinning remains. The patient underwent a penetrating keratoplasty for visual rehabilitation. CONCLUSIONS: Patient education with emphasis on compliance with nutritional supplements is essential after bariatric surgery. Consider vitamin A deficiency in the differential diagnosis of dry eye after LASIK surgery.

In vivo structural characteristics of the femtosecond LASIK-induced opaque bubble layers with ultrahigh-resolution SD-OCT.

The authors report in vivo morphology of opaque bubble layers with ultrahigh-resolution anterior-segment optical coherence tomography (UHR-OCT) in 3 patients. Two patients were operated on with a 30-kHz IntraLase femtosecond laser (Abbott Medical Optics, Abbott Park, IL) and one patient was operated on with a 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany). UHR-OCT images from the patient operated on with the 500-kHz femtosecond laser revealed that the opaque bubble layer extended anterior to the flap dissection plane up to Bowman's membrane. The lamellar flap dissection was incomplete in this patient. The opaque bubble layer in the patients operated on with the 30-kHz femtosecond laser extended posterior to the flap dissection plane and these patients experienced complete lamellar dissections with uncomplicated flap lifts. UHR-OCT imaging can be used to demonstrate the structural characteristics of OBL. It has the potential to be used to predict incomplete lamellar flap dissections in patients with opaque bubble layers.

Intraocular tuberculosis.

Intraocular manifestations of tuberculosis (TB) are rare, but TB infection is common worldwide, especially in developing economies, and in immigrant populations and immunocompromised patients in developed nations. The current review focuses on the clinical characteristics and diagnostic modalities useful in the diagnosis of intraocular TB. Specifically, IFN-gamma Release Assays (IGRAs), antigen-detection assays, and polymerase chain reactions will be discussed. Clinical management of TB patients includes counseling and testing for HIV infection. The use of corticosteroids along with anti-tuberculous medications and special therapeutic considerations in immunocompromised patients are discussed.

Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule.

OBJECTIVE: To review the clinical features and treatment of patients with retained nuclear fragments in the anterior chamber (AC). DESIGN: Single-center, retrospective, noncomparative, consecutive case series. PARTICIPANTS: Sixteen patients with a diagnosis of retained nuclear fragments in the AC. METHODS: Retrospective review of the medical records at Bascom Palmer Eye Institute in Miami, Florida, to identify all patients with a diagnosis of retained nuclear fragments in the AC after phacoemulsification surgery without rupture of the posterior capsule. Charts were reviewed and patient characteristics, ocular history, clinical findings, treatment (medical and surgical), and visual outcomes were recorded. MAIN OUTCOME MEASURES: Visual outcome and visual acuity at last follow-up visit. RESULTS: Most patients presented with corneal edema and anterior segment inflammation. All patients proved refractory to medical management, and surgical extraction of the retained lens fragment was required. Ten patients were myopic or had long axial lengths and/or steep keratometry readings. Three patients underwent penetrating keratoplasty for intractable corneal edema. One patient required a second surgery for fragment removal after a previous unsuccessful attempt at removal. Visual outcomes for the patients without macular disease who had lens fragment removal alone ranged from 20/20 to 20/40. Of the 2 patients without macular disease who underwent penetrating keratoplasty, the visual outcomes were 20/50 and 20/30. CONCLUSIONS: Retention of nuclear fragments in the AC may occur after phacoemulsification. This complication was associated with myopia in a majority of patients in this series, and we hypothesize that small fragments may hide in the posterior chamber in these larger eyes. Surgical removal was associated with a good visual outcome in patients without macular disease.