Outcomes of mitomycin C intravascular chemoembolization (MICE) in refractory corneal neovascularization after failed keratoplasty.

Corneal neovascularization is a determinant of corneal graft survival and preservation of immune privilege after keratoplasty. We report the outcomes in 2 patients with failed corneal grafts who underwent mitomycin C (MMC) intravascular chemoembolization (MICE) in the affected eye. A 30-year-old woman with failed penetrating keratoplasty (PK) in the right eye was started on prednisolone acetate eyedrops. Graft sutures were removed, and bevacizumab was injected subconjunctivally. The eye remained intermittently painful, and MICE was performed on the main feeding vessel, with regression of the vessels apparent within the first day following the procedure. The second case was a 40-year-old man who had a history of repaired penetrating injury in the left eye followed by failed PK. Prednisolone acetate eyedrops were initiated, and corneal sutures were removed. The patient failed to improve with three subconjunctival injections of bevacizumab. MICE was performed, but in this case neovascularization did not regress until 20 weeks post-procedure. MMC is thought to inhibit vascular endothelial cell proliferation, but its use in corneal injection is debated. In these cases, MICE was not associated with any concerning adverse events.

Primary non-Hodgkin lymphoma of the chiasm and optic tract in a nonimmunocompromised patient: illustrative case.

BACKGROUND: Chiasmatic and optic track lymphoma as the primary lesion of the central nervous system (CNS) is extremely rare. OBSERVATIONS: The authors report a case of a previously healthy 62-year-old woman who presented with quick and progressive visual impairment leading to bilateral blindness. Brain imaging studies suggested glioma or lymphoma of the chiasm and the posterior visual pathway. Postoperative examination revealed low-grade malignant B-cell lymphoma. No evidence of extracranial lymphoma was found, so a final diagnosis of primary CNS lymphoma (PCNSL) was made. LESSONS: To the authors' knowledge, PCNSL confined to the optic chiasm has rarely been reported in nonimmunocompromised patients. The present case of lymphoma affecting the optic chiasm and optic tract is extremely rare.

Assessment of the effect of cyclosporine-A 0.05% emulsion on the ocular surface and corneal sensation following cataract surgery.

AIM: To assess the effect of cyclosporine-A (CsA) 0.05% ophthalmic emulsion on corneal sensation and ocular surface problems following cataract surgery. DESIGN: Prospective, randomized, double masked clinical trial. METHODS: Consecutive case series of patients attending for bilateral cataract surgery. Subject's eyes were randomized to receive either topical CsA or carboxymethylcellulose 0.5% (CMC) eye drops twice daily for one month following routine cataract surgery. Subjective and objective assessments were performed pre-operatively, one week, and one month after surgery. Primary safety parameters included best spectacle-corrected visual acuity and incidence of adverse events. Objective assessments included tests of tear film (osmolarity, tear break-up time, and Schirmer's type-I test), ocular surface staining, corneal sensitivity and a subjective assessment: ocular surface disease index (OSDI) questionnaire. RESULTS: 30 subjects (60 eyes) were recruited. At one month following cataract surgery, osmolarity, ocular surface staining, TBUT, Schirmer's results showed a greater improvement after CsA drops compared to CMC and this was statistically significant for all measures (p<0.05). All corneal sensation measurements were reduced after one week and one month. Eyes receiving CsA had higher recovery of corneal sensation at both time points post operatively and this was statistically significant at one month. OSDI questionnaire results did not show a statistically significant difference between the two eyes. CONCLUSIONS: CsA is effective and safe in the management of ocular surface problems after cataract surgery and allows faster recovery of corneal sensation. This recovery of sensation may be relevant to the improvement in ocular surface problems in all patients.

Iris-claw, retropupillary-fixated, aphakic intraocular lens implantation for traumatic aphakia following penetrating keratoplasty.

We report the correction of aphakia using an iris-claw, aphakic intraocular lens (IOL) fixated in a retropupillary location in a 17-year-old young man who suffered blunt trauma to his eye 5 months after penetrating keratoplasty (PKP). There were no intraoperative complications. At 21 months after implantation, the patient's uncorrected distance visual acuity was 20/28; his corrected distance visual acuity was 20/22, with +0.50 -3.00 × 155. Intraocular pressure was normal, and endothelial cell count was 1798 cells/mm(2).

Posteriorly enclavated iris claw intraocular lens for aphakia: long-term corneal endothelial safety study.

PURPOSE: To report 2 years follow-up experience, corneal endothelial cell loss results, and A constant used in retroiridis-fixated iris-claw aphakic intraocular lens (IOL) secondary implantation to correct aphakia in eyes without adequate capsule support. METHODS: In this prospective, interventional, clinical case series, 16 consecutive eyes of 14 patients (13 adults and 1 child) underwent retroiridis implantation of Artisan iris-claw aphakic IOL (Ophtec BV, Groningen, the Netherlands). Outcome measures included spherical equivalent (SE) of refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), endothelial cell density (ECD), and complications, including raised intraocular pressure (IOP) and pigment dispersion. RESULTS: All eyes were followed up for 2 years postoperatively. Postoperative SE of refractive error was between -1.25 and +1.63 D in all eyes at last follow-up. The mean CDVA was 0.27 ± 0.30 logMAR preoperatively and 0.13 ± 0.21 logMAR at 2 years postoperatively (p = 0.0188). Postoperative UDVA mean was 0.31 ± 0.26 logMAR at last follow-up. Preoperative manual ECD mean of 2269 ± 611 cells/mm2 decreased postoperatively to 2002 ± 532 cells/mm2 at 2 years (p = 0.0005) (mean endothelial cell loss of 11.9 ± 2.0%). No intraoperative complications occurred. There was no significant postoperative IOP increase throughout the follow-up. Iris pigment precipitates on the IOLs occurred in 1 eye (6.3%). No other serious complications occurred. CONCLUSIONS: Two-year results show that retroiridis-fixated iris-claw aphakic IOL implantation is an effective and safe method with regards to corneal endothelial cell loss, and a new A constant is suggested.

Artisan iris-fixated toric phakic intraocular lens for the correction of high astigmatism after deep anterior lamellar keratoplasty.

We report the refractive correction of high astigmatism in one eye of a 23-year-old woman following deep anterior lamellar keratoplasty (DALK) using an Artisan iris-fixated, toric, phakic intraocular lens (IOL). One year after implantation, uncorrected and corrected distance visual acuities were both 20/25, refraction was -1.00 D cylinder, and the endothelial cell count was 1827 cells/mm(2). Iris-fixated phakic IOLs are not recommended for every postkeratoplasty patient with high refractive error; however, this procedure can offer good outcomes in carefully selected cases of previous DALK.

Autologous cryoprecipitate for attaching conjunctival autografts after pterygium excision.

PURPOSE: To report the efficacy, safety, and reliability of autologous cryoprecipitate in pterygium excision surgery and to compare it with the traditional method of using absorbable sutures, in regard to surgical time and the patient comfort. MATERIALS AND METHODS: A prospective interventional clinical study was carried out in a specialized eye clinic. A total of 54 patients (90 eyes) underwent surgical excision of the nasal pterygium (whether primary or recurrent) with conjunctival autograft obtained from the same eye. Patients were divided into two groups. Autologous cryoprecipitate was used in 47 eyes (glue group), and absorbable sutures (8/0 vicryl) were used in 43 eyes (suture group) to attach the free conjunctival graft. There were 42 primary and 48 recurrent nasal pterygia that were included in the study. The surgical time was noted, and post-operative pain was graded. Follow-up period ranged from 6 months to 18 months (mean 12 months). P < 0.05 was statistically significant. RESULTS: The medians of the visual analogue scale values were significantly lower in the glue group (P < 0.05). The median surgical time was statistically significantly lower at 11 min (range 9 min to 15 min) in the glue group, compared to 21 min (range 12 min to 28 min) for the suture group (P < 0.05). No significant intraoperative or post-operative complications were noted. Recurrence rate was 12%, and all recurrence cases occurred in the sutures group. CONCLUSIONS: Application of autologous cryoprecipitate glue instead of sutures for attaching the free conjunctival graft in pterygium surgery resulted in less post-operative pain and shorter surgical time. Additionally, there were no cases of recurrence during the follow-up in patients who received autologous cryoprecipitate glue during pterygium surgery.