Comparison of manual and femtosecond laser arcuate keratotomy procedures for the correction of post-keratoplasty astigmatism.

PURPOSE: To compare the effectiveness of femtosecond laser (FSL) assisted and manual arcuate keratotomy (AK) procedures for the correction of postkeratoplasty astigmatism. METHODS: Fifty-two eyes (52 patients) were treated with FSL assisted AK and 53 eyes (51 patients) with manual AK for post-keratoplasty astigmatism. The main outcome measures included preoperative and postoperative manifest refraction, uncorrected and corrected distance visual acuity (UDVA, CDVA), corneal topography and complications. RESULTS: In FSL group, UDVA changed significantly from 0.90 ±â€¯0.43 preoperatively to 0.60 ±â€¯0.39 at last follow-up (p = 0.001). In manual group, preop- (0.87 ±â€¯0.35) and post-operative UDVA (0.93 ±â€¯042) were comparable (p = 0.535). CDVA improved from 0.30 ±â€¯0.18 preoperatively to 0.20 ±â€¯0.14 at last follow-up visit in FSL group (0.014) and 0.28 ±â€¯0.15 preoperative to 0.23 ±â€¯0.19 at last postoperative visit (0.074) in manual group. Postoperative UDVA and CDVA were comparable between both the groups (p > 0.05). The mean preoperative refractive cylinder was 6.38 ±â€¯3.73 and 7.15 ±â€¯132, decreasing significantly to 5.06 ±â€¯2.06 and 5.19 ±â€¯2.25 after manual and FSL assisted AK procedures respectively. Mean change in the refractive cylinder was -1.10 ±â€¯4.11 in manual AK group and -2.19 ±â€¯2.35 in FSL group (p = 0.134). Perforation, overcorrection and regression occurred in respectively 3 eyes (5.8%), 12 eyes (23.07%) and 1 eye (1.92%) in FSL group and 1 eye (1.9%; macro-perforation), 7 eyes (13.21%) and 8 eyes (15.09%) in manual group. Additionally, in the manual group, severe ectasia occurred in 1 eye (1.9%). CONCLUSION: FSL assisted AK procedure is comparable or to a certain extent better regarding safety and efficacy than manual AK procedure. Postoperatively, FSL resulted in better outcomes of UCVA, BCVA, refractive cylinder and keratometric astigmatism compared to the manual AK procedures; although, the difference between the groups was not statistically significant.

Causes of Phakic Implantable Collamer Lens Explantation/Exchange at King Khaled Eye Specialist Hospital.

PURPOSE: The purpose of this study is to evaluate the causes of phakic implantable collamer lens (ICL) explantation/exchange at an eye hospital in Saudi Arabia. MATERIALS AND METHODS: A retrospective chart review was performed for patients who underwent ICL implantation from 2007 to March 2014 and data were collected on cases that underwent ICL explantation. RESULTS: Of the 787 ICL implants, 30 implants (3.8% [95% confidence interval 2.6%; 5.3%]) were explanted. The causes of explantation included incorrect lens size (22), cataract (4), high residual astigmatism (2), rhegmatogenous retinal detachment (1), and intolerable glare (1). Corrective measures mainly included an exchange with an appropriately sized lens (9), ICL explantation (11), with phacoemulsification and posterior chamber intraocular lens implantation (6), or replacement with an ICL of correct power (2). CONCLUSION: Incorrect ICL size was the most common cause of ICL explantation. More accurate sizing methods for ICL are required to reduce the explantation/exchange rate.

Femtosecond astigmatic keratotomy for postkeratoplasty astigmatism.

PURPOSE: To evaluate the initial outcomes of femtosecond laser arcuate keratotomies (AK) to correct high astigmatism after keratoplasty. METHODS: This retrospective non-comparative interventional study included 52 consecutive patients (52 eyes) who underwent Intralase-enabled arcuate keratotomies. Changes in uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), mean refractive and keratometric astigmatism, preoperative and postoperative manifest refraction and complications were the main outcome measures. RESULTS: The mean follow-up period was 13.77 ± 4.17 months. Mean BCVA and UCVA improved statistically significantly from 0.30 ± 0.18 LogMAR and 0.90 ± 0.43 LogMAR preoperatively to 0.20 ± 0.14 and 0.60 ± 0.39 postoperatively respectively (P < 0.05, all comparisons). Mean subjective cylinder decreased statistically significantly from 7.15 ± 1.32 D preoperatively to 5.19 ± 2.25 D at the last postoperative visit (P = 0.0002). Two eyes (4%) lost one line or more of BCVA. Three patients (5.8%) had corneal perforation and only one eye required resuturing of the AK wound. Twelve patients (23%) were overcorrected. CONCLUSIONS: AK performed with the femtosecond laser was relatively easy to perform, safe, and effective for treating post-keratoplasty astigmatism. There was a significant improvement in UCVA and BCVA with a very low rate of complications. A larger series is required to refine the nomogram to achieve a greater reduction in cylinder.

The neurology of carbonic anhydrase type II deficiency syndrome.

Carbonic anhydrase type II deficiency syndrome is an uncommon autosomal recessive disease with cardinal features including osteopetrosis, renal tubular acidosis and brain calcifications. We describe the neurological, neuro-ophthalmological and neuroradiological features of 23 individuals (10 males, 13 females; ages at final examination 2-29 years) from 10 unrelated consanguineous families with carbonic anhydrase type II deficiency syndrome due to homozygous intron 2 splice site mutation (the 'Arabic mutation'). All patients had osteopetrosis, renal tubular acidosis, developmental delay, short stature and craniofacial disproportion with large cranial vault and broad forehead. Mental retardation was present in approximately two-thirds and varied from mild to severe. General neurological examinations were unremarkable except for one patient with brisk deep tendon reflexes and two with severe mental retardation and spastic quadriparesis. Globes and retinae were normal, but optic nerve involvement was present in 23/46 eyes and was variable in severity, random in occurrence and statistically correlated with degree of optic canal narrowing. Ocular motility was full except for partial ductional limitations in two individuals. Saccadic abnormalities were present in two, while half of these patients had sensory or accommodative strabismus, and seven had congenital nystagmus. These abnormalities were most commonly associated with afferent disturbances, but a minor brainstem component to this disorder remains possible. All internal auditory canals were normal in size, and no patient had clinically significant hearing loss. Neuroimaging was performed in 18 patients and repeated over as long as 10 years. Brain calcification was generally progressive and followed a distinct distribution, involving predominantly basal ganglia and thalami and grey-white matter junction in frontal regions more than posterior regions. At least one child had no brain calcification at age 9 years, indicating that brain calcification may not always be present in carbonic anhydrase type II deficiency syndrome during childhood. Variability of brain calcification, cognitive disturbance and optic nerve involvement may imply additional genetic or epigenetic influences affecting the course of the disease. However, the overall phenotype of the disorder in this group of patients was somewhat less severe than reported previously, raising the possibility that early treatment of systemic acidosis with bicarbonate may be crucial in the outcome of this uncommon autosomal recessive problem.

Hemangioendothelioma of the eyelid can mimic chalazion.

Hemangioendothelioma is an uncommon vascular lesion that usually occurs in the liver, bone, lung, skin, and other organs with unknown etiology. A rare form of this lesion has been reported in the eyelid. We report the case of a 27-year-old female with right lower eyelid mass simulating chalazion of 3 weeks duration. The histopathologic examination of the excised nodule confirmed the diagnosis. To our knowledge, this is the fourth case of eyelid epithelioid hemangioendothelioma reported in the English literature.