[SILK--Steroid-induced lamellar keratopathy. A case report]. / SILK-steroidinduzierte lamelläre Keratopathie. Ein Fallbericht.

CASE REPORT: After uneventful myopic LASIK, both interfaces of a 31-year-old, healthy male patient showed 5 days (right eye) and 7 days (left eye) postoperatively a diffuse, multifocal infiltration confined to the flap interface which was interpreted as a diffuse lamellar keratitis, stage 2-3. The routine postoperative treatment with local antibiotics and steroids was intensified to local steroids hourly. At that time intraocular pressure (IOP) was 19 mmHg (right) and 18 mmHg (left) (centrally measured by Goldmann applanation tonometry). Following 2 weeks under this therapy the keratitis did not resolve and IOP increased up to 30 mmHg. Local and systemic antiglaucomatosa were administered and IOP was reduced to 22 and 24 mmHg, respectively. Corneal interface infiltration, however, remained unchanged. Only the complete stop of the local corticosteroids induced a rapid regression and corneal transparency returned. IOP was normalized down to 10 mmHg without additional therapy. DISCUSSION: 1) It is essential to measure IOP in the early postoperative phase after LASIK, especially in cases of corneal haze. 2) After corneal refractive surgery with high corneal ablation, IOP data in the upper range has to be interpreted as pathological. 3) Steroid-induced lamellar keratopathy is postulated as being a separate entity. 4) In cases of stromal infiltration after LASIK and increased IOP, local steroids have to be reduced immediately.

[Pars plana vitrectomy in cystoid macular edema of different forms of chronic uveitis]. / Pars-plana-Vitrektomie bei zystoidem Makulaödem bei verschiedenen Formen der chronischen Uveitis.

BACKGROUND: Cystoid macular edema (CME) is a common complication in different forms of chronic uveitis. In spite of immunosuppressive and anti-inflammatory therapy, chronic or relapsing courses can occur which may have a negative impact on visual prognosis. Pars plana vitrectomy (PPV) is known to positively influence chronic uveitis. This retrospective study was performed to investigate the role of PPV in the therapy refractive uveitic CME. PATIENTS AND METHODS: PPV for CME was performed in eyes with CME in intermediate uveitis (IMU, n=42), chronic iridocyclitis in juvenile rheumatoid arthritis (CIC, n=14) and multifocal chorioretinitis (MFC, n=12). In none of the eyes had immunosuppressive and/or anti-inflammatory therapy or anti-edema treatment (e.g.acetazolamide) led to regression of the CME. After a postoperative follow-up period of 7 and 106 months all patients were re-examined. RESULTS: Postoperative complete or partial regression of CME was observed as follows: IMU: 25/42 (59.5%), CIC: 8/14 (57.1%),MFC: 5/12 (41.7%). A significant increase in visual acuity of 2 lines and more was observed in 50%,71.4% and 41.7% of eyes, respectively. In the long-term follow-up best functional results were achieved in eyes with IMU. CONCLUSIONS: Response to PPV was variable according to the type of underlying form of uveitis. The lowest success rate could be observed in eyes with MFC. Although the postoperative regression rate of CME was satisfactory in eyes with CIC, long-term visual acuity results were disappointing due to secondary complications of CIC in this young age group. Best results were achieved in patients with IMU (statistically not significant). A multicenter study in a larger series of patients is needed to investigate the exact role of PPV in different forms of chronic uveitis.