Femtosecond Laser-Assisted Penetrating Keratoplasty for Treating Infective Keratitis.

PURPOSE: To report the results of penetrating keratoplasty (PKP) assisted by femtosecond laser in the treatment of persistent infective keratitis. METHODS: Seven eyes of 7 patients with diagnosed infective keratitis were recruited. They showed no improvement on maximal medical therapy for a week. The causative organisms were Pseudomonas aeruginosa in 3 cases and Fusarium in 4 cases. All cases underwent femtosecond laser-assisted PKP with a mushroom-shaped cut. Postoperative antimicrobial medications were continued for 8-12 weeks. Sutures were removed after 6 months. Therapeutic success was defined as eradication of primary infection. Functional success was considered when visual function improves to 20/200 or better. RESULTS: All 7 eyes underwent femtosecond laser-assisted PKP. There were no intraoperative complications, and all patients had uneventful recipient cornea separation. Anatomic, therapeutic, and functional success was achieved in all patients. During the 6-month follow-up period, no recurrence of infection was reported. The average preoperative corrected distance visual acuity (CDVA) was 2.07 log of the minimal angle of resolution (LogMAR) ± 0.21, whereas at 6 months postoperatively, the average CDVA was 0.17 LogMAR ± 0.13, with a P value of 0.00025. CONCLUSIONS: Femtosecond laser-assisted PKP was found to be an effective method for treating infective keratitis (particularly that caused by Pseudomonas aeruginosa and Fusarium) that did not respond to medical treatment. Early surgical intervention before the disease becomes advanced is recommended.

SMILE With Low Energy Levels: Assessment of Early Visual and Optical Quality Recovery.

PURPOSE: To assess early visual and optical quality recovery according to preoperative refraction after small incision lenticule extraction (SMILE) at low energy level for myopia and myopic astigmatism treatment. METHODS: This prospective study included 101 eyes of 101 patients separated into three groups: low myopia (30 eyes), with a mean spherical equivalent (SE) of -2.13 ± 0.73 diopters (D); moderate myopia (33 eyes), with a mean SE of -4.53 ± 0.86 D; and high myopia (38 eyes), with a mean SE of -6.54 ± 0.78 D. Visual acuity, contrast sensitivity, refraction, corneal higher order aberrations, modulation transfer function, Strehl ratio, and Objective Scatter Index (OSI) were measured. RESULTS: All eyes had a corrected distance visual acuity of 20/20 or better at 1 day in the low myopia group and 1 month in the moderate and high myopia groups. The contrast sensitivity preoperative values recovered at 8 days in the low myopia group and 1 month in the moderate and high myopia groups. At 1 month, the low myopia group recovered the OSI preoperative values (0.61 to 0.69) and the OSI values were slightly higher than the preoperative value in the moderate and high myopia groups (0.74 to 1.00 and 0.8 to 1.14, respectively). CONCLUSIONS: The recovery time of visual and optical quality in the first month after SMILE correlated with preoperative refraction and the amount of postoperative scattering. Patients with low myopia recovered visual acuity faster and with less ocular scattering than patients with moderate or high myopia. [J Refract Surg. 2019;35(5):285-293.].

Photochemical tissue bonding: a potential strategy for treating limbal stem cell deficiency.

BACKGROUND AND OBJECTIVE: To determine the feasibility of attaching human amniotic membrane (HAM), pre-cultured with limbal stem cells (LSCs), to cornea using a novel, light-activated tissue bonding method. MATERIALS AND METHODS: LSCs were isolated from rabbit eyes, and then cultured on de-epithelialized HAM to create grafts (HAM/LSC). These were then transplanted onto rabbit eyes with surgically created limbal stem cell deficiency (LSCD). The grafts were secured either by sutures or by a light-activated method called photochemical tissue bonding (PTB). Outcomes included corneal opacity, inflammation, neovascularization, and collagen alignment. RESULTS: The isolated and cultured cells were verified to be LSCs based on their K19+/intergrin ß1+/P63+/K3 profile. Securing the HAM/LSC graft with PTB provided better outcomes. At 28 days post-surgery, the corneal opacity scores were significantly lower after securing the graft with PTB compared with suture attachment (0.8 ± 0.5 vs. 1.8 ± 0.5, P < 0.01). Similarly, neovascularization scores were lower after PTB (0.8 ± 0.5 vs. 1.5 ± 0.6, P < 0.01). Quantification of MPO and CD31 levels from immunofluorecent staining indicated that PTB stimulated less neutrophil infiltration (5.3 ± 2.2 vs. 13.3 ± 3.1, P < 0.01) and less new blood vessels formation (2.0 ± 0.8 vs. 6.3 ± 1.3, P < 0.01) at the wound site. The collagen alignment in PTB-treated corneas, as shown by immunofluorescence and second harmonic generation image, was better organized in the PTB-treated group than in the suture group. CONCLUSION: Bonding LSC grafts with PTB produced improved outcomes compared to suture attachment. This light-activated method is a promising modality for treating patients with LSCD.

Combined Treatment for Band Keratopathy

No abstract available.