Long-term stability of keratometric astigmatism after limbal relaxing incisions.

PURPOSE: To study the keratometric stability of limbal relaxing incisions (LRIs) performed during cataract surgery. SETTING: Princess Royal University Hospital, Kent, United Kingdom. DESIGN: Retrospective case series. METHODS: Medical notes of patients who had small-incision cataract surgery combined with LRIs between November 2006 and December 2010 were reviewed. Keratometric astigmatism was measured using Scheimpflug pachymetry (Pentacam). Surgically induced astigmatism (SIA) was calculated using the Astig Plot application. RESULTS: Twenty eyes of 20 patients were evaluated. The median keratometric astigmatism preoperatively and 2 weeks, 10 weeks, and 3 years postoperatively was 2.1 diopters (D) (interquartile range [IQR], 1.7 to 2.4 D), 1.3 D (IQR, 0.9 to 2.1 D), 1.2 D (IQR, 0.5 to 1.7 D), and 1.0 D (IQR, 0.7 to 1.4 D), respectively. There were no significant differences in keratometric astigmatism between 2 weeks and 10 weeks postoperatively (P=.35) or between 10 weeks and 3 years postoperatively (P=.72). The median SIA 2 weeks, 10 weeks, and 3 years postoperatively was 2.2 D (IQR, 1.6 to 4.1 D), 2.1 D (IQR, 1.2 to 2.7 D), and 1.8 D (IQR, 1.2 to 2.5 D), respectively. There was a statistically significant difference in SIA between 2 weeks and 10 weeks postoperatively (P=.002) but not between 10 weeks and 3 years postoperatively (P=.72). CONCLUSION: The keratometric effects of LRIs were stable from 10 weeks to 3 years postoperatively. FINANCIAL DISCLOSURE: Dr. Borasio is the creator of Astig Plot. No other author has a financial or proprietary interest in any material or method mentioned.

Isolated orbital fibrous dysplasia associated with ipsilateral keratoconus.

INTRODUCTION: Fibrous dysplasia is a primary orbital bone tumor, described as a benign disorder in which proliferation of fibrous tissue and osteoid replaces and distorts the bone from which it derives. Unilateral keratoconus is a rare entity. Herein, we report a case of an extensive ethmoidal fibrous dysplasia associated with ipsilateral keratoconus, and review the literature on the subject. MATERIALS AND METHODS: A 22-year-old man presented with left painless proptosis evolving over 10 years. There was associated ipsilateral epiphora and gradual visual loss. On examination his visual acuity was 20/20 OD and CF OS. His left globe was displaced lateraly 12 mm, with 9 mm of proptosis. The extraocular movements were normal. Left nasolacrimal duct obstruction was noted. Clinical signs of keratoconus were present only in the left cornea. High resolution corneal topography confirmed unilateral keratoconus and a CT scan showed an ovoid mass with a well defined sclerotic margin arising from the left ethmoid sinus and invading the orbit. RESULTS: The patient underwent resection of the lesion via a modified Lynch incision. Complete regression of proptosis was observed immediately after surgery. Histopathological examination revealed irregular trabeculae of woven bone in different levels of maturation in a moderately cellular fibrous matrix without nuclear atypia. Trabeculae were without osteoblastic rimming or osteoclastic resorption. There has been no recurrence over a 2-year follow-up period. CONCLUSION: To our knowledge, the coexistence of unilateral isolated craniofacial fibrous dysplasia with ipsilateral keratoconus has not been reported so far.

Persistent corneal endothelial deposits associated with rifabutin therapy for Crohn's disease.

PURPOSE: To report a case of corneal endothelial deposits associated with rifabutin therapy for Crohn's disease. METHOD: Case report, anterior segment photography, and current literature search. RESULTS: Persistence of corneal endothelial deposits was found to occur in a 55-year-old gentleman 6 years after cessation of a 3-year course of rifabutin. The corneal deposits were not associated with lenticular findings or retinal dysfunction, the latter side effect being published in a recent research article. CONCLUSIONS: This is only the second published case of corneal deposits in conjunction with rifabutin therapy for Crohn's disease. This case uniquely confirms the persistence of the corneal deposits longer than previously documented.

Keratitis after intracorneal ring segment insertion for keratoconus.

We report a case of sterile keratitis after Ferrara intracorneal ring (Ferrara Ophthalmics) implantation into the right cornea of a keratoconus patient who also suffered from atopic blepharoconjunctivitis. The keratitis resolved within a few days after removal of the Ferrara rings. Ocular atopy with sterile keratitis should be considered in the differential diagnosis of keratitis after the insertion of intracorneal ring segments, which can be easily treated by ring removal.

Corneal wedge resection to treat progressive keratoconus in the host cornea after penetrating keratoplasty.

We present 3 cases of progressive keratoconus in the host after penetrating keratoplasty PKP that were treated with a wide crescentic excision of the diseased tissue in the host cornea guided by Orbscan II topography (Bausch & Lomb). In all cases, the procedure resulted in a more regular corneal shape with a marked reduction in astigmatism, preventing the need for repeat PKP

Long-term outcomes of keratolimbal allograft for the treatment of severe ocular surface disorders.

PURPOSE: To investigate the long-term outcome of keratolimbal allograft (KLAL) for the treatment of severe ocular surface disorders. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty patients (23 eyes) with severe ocular surface disorders. INTERVENTION: Thirty-three KLAL procedures were performed. Ten patients (10 eyes) underwent KLAL in combination with other surgical procedures. Oral or topical cyclosporine or both were used after surgery in 15 patients to prevent allograft rejection. MAIN OUTCOME MEASURES: Reconstruction of the ocular surface with restoration of phenotypic corneal epithelium, reduction of corneal vascularization and conjunctivalization, decreased pain, and visual improvement. RESULTS: The mean follow-up was 60 months (range, 15-96 months). Eight eyes (24.2%) never reepithelialized and were considered primary failures. The remaining 25 grafts initially restored a phenotypic corneal epithelium, but at last follow-up only 7 (21.2%) were stable. Graft survival rate was 54.4% at 1 year, 33.3% at 2 years, and 27.3% at 3 years. Visual acuity improved or was unchanged in 19 eyes (82.6%) and decreased in 4 eyes (17.4%). Seventeen corneal transplantations (3 lamellar keratoplasties and 14 penetrating keratoplasties) were performed either in combination with or after a KLAL. All three lamellar keratoplasties were successful, whereas 13 of the 14 penetrating keratoplasties failed. Cyclosporine was used initially in high-risk recipients and later in all recipients. Allograft rejection episodes occurred in 13 KLAL procedures of 11 eyes (39.4%) and were more common in patients treated with cyclosporine compared with the untreated group (87.5% vs. 22.2%). Graft survival was longer in the cyclosporine-treated group compared with the untreated group. CONCLUSIONS: Keratolimbal allograft is useful in ocular surface reconstruction and restores phenotypic corneal epithelium. Graft survival rate, however, decreases dramatically over a 2-year period. Long-term use of cyclosporine appears to prolong graft survival but does not prevent acute allograft rejections.