Indications for orbital decompression for patients undergoing keratoprosthesis surgery.

INTRODUCTION: Optimizing the ocular surface and achieving acceptable cosmesis are important considerations in the rehabilitation of patients with keratoprosthesis (KPro). In osteo-odonto-KPro and type 1 Boston KPro surgery, it is important to ensure a healthy ocular surface to increase the chance of functional success. MATERIALS AND METHODS: The authors present 2 patients with KPros undergoing orbital decompression surgery. This series highlights a novel indication for orbital decompression surgery for patients, who are usually 1-eyed, undergoing KPro surgery. It illustrates the importance of globe position to either optimize the ocular surface or allow a cosmetic shell to be worn. To the authors' knowledge, such indications for orbital decompression have not been reported to date. RESULTS: Two-wall and intraconal fat orbital decompression surgery achieved globe retroplacement of 6 mm and 7 mm, allowing fitting of a cosmetic shell over the osteo-odonto-KPro and reducing lagophthalmos and corneal exposure in patients 1 and 2, respectively. CONCLUSION: Indications for orbital decompression exist in patients undergoing osteo-odonto-KPro or KPro to reduce pseudoproptosis or exposure.

Detection of laminar resorption in osteo-odonto-keratoprostheses.

PURPOSE: To compare the clinical examination and computerized tomography (CT) scanning methods for the detection of laminar resorption in eyes with osteo-odonto-keratoprosthesis (OOKP). METHODS: Patients who developed laminar resorption after OOKP surgery and had at least one CT scan of the lamina during the follow-up were included. Case records and CT images and reports were retrospectively reviewed. Each lamina of the eye was regarded as a case. The imaging and clinical data were collected in Microsoft Excel, and statistical analysis was performed on Stata-v14. The agreements and sensitivities of both the methods were compared. RESULTS: Forty patients out of 64 were found to have laminar resorption. A total of 48 laminae were studied, which had data on the presence or absence of resorption. The sensitivity and specificity of clinical detection of resorption were 87.5% (CI 68%-97%) and 37.5% (CI 8.5%-75.5%), respectively. Whereas, the sensitivity and specificity of CT scan were 81% (CI 61%-93%) and 50% (CI12%-88%), respectively. Both the methods have detected resorption in 21 out of 32 laminae having both the clinical and CT scan data. There is a fair agreement between the two techniques in the identification of thinned laminar sites. CONCLUSIONS: Clinical detection of laminar resorption in OOKP eyes is equally sensitive to the CT scanning. Resorption can be detected even in its early stages by clinical palpation in experienced hands. Frequent CT scanning is not indicated to detect laminar resorption. Both methods complement each other. Thinned laminar segments should be compared and correlated with both the methods for full evaluation of resorption.

The risk of ischemic optic neuropathy post phacoemulsification cataract surgery.

INTRODUCTION: The aim was to study the risk of non arteritic ischemic optic neuropathy after phacoemulsification cataract surgery. METHODS: This study was conducted at King Hussein Medical Center during the period between January 2015 and July 2016. Patients attending ophthalmology clinic complaining of decreased vision due to lens opacity were evaluated. Patients were divided into two groups. First group included patients with no medical illness and second group included patients with diabetes mellitus, hypertension or hyperlipidemia. The two groups were further divided into two subgroups. First subgroup included patients who had phacoemulsification surgery and second subgroup did not have surgery. All patients were followed up for 6 months. They were assessed by neuro-ophthalmologist looking for ischemic optic neuropathy. RESULTS: A total number of 568 patients were enrolled. Group 1A included patients with no medical illness who underwent surgery and group 1B did not undergo surgery. The number of patients in these two subgroups was 119 and 103 respectively. Number of patients in group 2A (medical illness and surgery) was 188 and number of patients in group 2B (medical illness and no surgery) was 130. The incidence of ischemic optic neuropathy was 4.3 % in group 2A, 4.2 % in group 1A, 0.8% in group 2B, and 0% in group 1B. CONCLUSION: Phacoemulsification is a risk factor for non arteritic ischemic optic neuropathy independent of the presence of medical risk factors. Suggested mechanisms would be local anaesthesia, intraocular pressure fluctuation and local intraocular inflammation.