Results of cataract surgery and plasma ablation posterior capsulotomy in anterior persistent hyperplastic primary vitreous.

PURPOSE: To report the feasibility and outcome of lens aspiration, and Fugo blade-assisted capsulotomy and anterior vitrectomy in eyes with anterior persistent hyperplastic primary vitreous (PHPV). MATERIALS AND METHODS: In this case series, 10 eyes of 10 patients with anterior PHPV underwent lens aspiration. The vascularized posterior capsule was cut with a Fugo blade (plasma knife) and removed with a vitrector. A foldable posterior chamber intraocular lens (IOL) was implanted in eight eyes and the outcomes were evaluated. RESULTS: The mean age of patients was 16.8 ± 6.37 months (range: 5 to 28 months). The surgery was completed successfully in all eyes. There were no cases of intraocular hemorrhage intraoperatively. Foldable acrylic IOL was implanted in the bag in 3 eyes and in the sulcus in 5 eyes. Two eyes were microphthalmic and did no undergo IOL implantation (aphakic). None of the eyes had a significant reaction or elevated intraocular pressure postoperatively. The follow-up ranged from 4 to 21 months. All the pseudophakic eyes achieved a best corrected visual acuity of ≥20/200 with 50% (4/8) of these eyes with ≥20/60 vision. CONCLUSION: Lens aspiration followed by posterior capsulotomy with Fugo blade-assisted plasma ablation is a feasible technique for performing successful lens surgery in cases with florid anterior PHPV.

Optimal use of donor corneal tissue: one cornea for two recipients.

PURPOSE: To evaluate the feasibility, safety, and efficacy of the use of 1 donor cornea for 2 recipients who required anterior lamellar and posterior lamellar keratoplasties, respectively. METHODS: Twelve eyes with anterior corneal stromal pathology and 12 eyes with irreversible endothelial dysfunction were evaluated for transplant surgery at a tertiary eye care referral center. Twelve healthy donor corneas were split into 2 parts, that is, anterior lamellar button (350-µm-thick) and posterior lamellar button (150-µm-thick) using a microkeratome (Moria, Antony, France). The anterior lamellar button was used to perform automated lamellar therapeutic keratoplasty in 12 eyes, and the posterior lamellar button was used to undertake Descemet stripping automated endothelial keratoplasty in 12 eyes. The parameters evaluated were feasibility of the procedure, intraoperative and postoperative complications, if any, and visual outcome. RESULTS: It was possible to use 12 donor tissues for 24 patients as envisaged. No intraoperative or postoperative complications were observed. In the automated lamellar therapeutic keratoplasty group, 83.3% (10 of 12) of patients achieved a best-corrected visual acuity (BCVA) of >20/60, and in the Descemet stripping automated endothelial keratoplasty group 75% (9 of 12) of patients achieved a BCVA of >20/60. CONCLUSIONS: Our study demonstrates that 1 donor corneal tissue can be successfully used for 2 patients as a routine practice with appropriate and optimal case selection. Such techniques may help to reduce the magnitude of corneal blindness in developing countries where there are shortages of donor corneal tissue.

Laser in-situ keratomileusis for refractive error following radial keratotomy.

AIM: To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK). DESIGN: Retrospective study. MATERIALS AND METHODS: A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively. STATISTICAL SOFTWARE: STATA-9.0. RESULTS: The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 ( P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen's acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was -5.37 ± 4.83 diopters (D) and -0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK. CONCLUSION: LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap.

Surgical technique of deep anterior lamellar keratoplasty in descemetoceles.

PURPOSE: To describe a surgical technique of deep anterior lamellar keratoplasty (DALK) to treat patients with descemetocele. METHODS: Twelve eyes of 12 patients with central or paracentral descemetocele after resolved microbial keratitis underwent viscoelastic-assisted DALK. The mean follow-up of the cases was 19.91 ± 15.80 months (range: 6-48 months). RESULT: In all the eyes, a successful DALK could be performed without any intraoperative complications. At the last follow-up visit, all but 1 eye showed significant improvement in visual acuity compared with preoperative visual acuity. The postoperative best-corrected visual acuity did not improve in 1 patient because of glaucomatous optic atrophy, which was present preoperatively. Eight eyes had best-corrected visual acuity of ≥ 20/80, and all but 2 patients had clear grafts at the final follow-up. None of the patients had any evidence of graft infection. CONCLUSIONS: Viscoelastic-assisted DALK is a useful therapeutic option in selected cases of descemetocele after resolved microbial keratitis.