RESUMO
Two cases of necrotizing keratitis following laser refractive corneal surgery, with stable and controlled Crohn's disease are described. A 40-year-old woman developed bilateral stromal inflammation and inferior thinning in the right eye along the flap edge within 1 day of uneventful bilateral IntraLase laser-assisted in situ keratomileusis. The other case is a 30-year-old man who also developed bilateral inferior stromal infiltrates 2 days following photorefractive keratectomy. Both cases were aggressively treated with systemic and topical corticosteroids. The infiltrates in both patients gradually resolved, with one relapse during the 7 months period of follow-up in the first case. These cases highlight the importance of taking precautions considering this and similar autoimmune conditions as a relative contraindication to refractive surgery.
RESUMO
PURPOSE: To evaluate the clinical outcomes of implantation of the Implantable Collamer Lens collagen copolymer toric phakic intraocular lens (pIOL) to correct myopic astigmatism in eyes with mild pellucid marginal degeneration (PMD). SETTING: Gimbel Eye Centre, Calgary, Alberta, Canada. DESIGN: Retrospective chart review. METHODS: All consecutive cases with PMD that had implantation of the toric pIOL from January 1, 2003, to May 30, 2011, were retrospectively reviewed for postoperative outcomes. Perioperative variables of interest included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and corneal topography. RESULTS: The study comprised 10 eyes of 5 patients. The mean age was 37.4 years ± 2.6 (SEM). The mean CDVA was 0 ± 0.03 logMAR (20/20) preoperatively and -0.04 ± 0.03 logMAR (20/18) postoperatively. The mean postoperative UDVA was +0.14 ± 0.05 logMAR (20/28). The mean spherical equivalent (SE) was -6.71 ± 0.9 diopters (D) preoperatively and -0.58 ± 0.1 D at the last follow-up. All eyes had improved CDVA after surgery. One patient reported severe glare and halos in 1 eye postoperatively, requiring removal and replacement of the toric pIOL because of a hyperopic refractive surprise. The new toric pIOL was subsequently repositioned because of high residual astigmatism related to changes in corneal topography postoperatively and a small shift in the position of the toric pIOL. The final manifest refraction for this eye was plano -1.00 × 160. CONCLUSIONS: Implantation of the collagen copolymer toric pIOL was a safe, effective surgical procedure for the correction of myopic astigmatism in eyes with mild PMD.